Abstract 3452: The Significance of Health Care-Associated Infection in Prosthetic Valve Infective Endocarditis
Introduction: An increase in the incidence of S. aureus endocarditis has been associated with health care exposure. Although early prosthetic valve infective endocarditis (PVIE) within 60 days of valve implantation is well recognized, the broader effect of health care-associated infection (HCA) on PVIE is unknown.
Hypothesis: Health care-associated infection is an important factor in the causation, clinical characteristics and outcome of PVIE.
Methods: In the International Collaboration on Endocarditis Prospective Cohort Study (ICE-PCS), 556 patients with definite PVIE by Duke criteria were enrolled between 2000–2005. Univariable comparisons were made between
early versus late PVIE and
HCA and community-acquired PVIE.
Multivariable analyses were performed to determine variables independently associated with HCA PVIE and the effect of HCA on in-hospital mortality.
Results: HCA PVIE was present in 148/556 (26.6%) and a strong direct correlation was present between percentage of HCA PVIE and staphylococcal infection across all geographic regions (r=0.713, p<0.001). Early PVIE, in 13.8%, was associated with a significantly higher rate of HCA PVIE than in late PVIE (79.3% vs. 16.9%, p<0.001), but the majority (54%) of HCA PVIE occurred beyond the early period. Among the broader group of HCA PVIE, diagnosis of PVIE <1 year after valve implantion occurred in 79% vs. 23% of community-acquired PVIE cases. Comparisons between HCA and community-acquired PVIE are shown in the Table⇓. After adjusting for these differences, an intravascular access device source was independently associated with HCA PVIE. In multivariable analysis, HCA PVIE was a significant predictor of in-hospital mortality (OR 1.8, 95% CI 1.1, 2.9).
Conclusions: Health care-associated infection significantly impacts the timing, microbiology, complications and prognosis of PVIE. Studies are needed to determine better preventive and therapeutic strategies for this serious clinical entity.