Abstract P349: Trends in Endocarditis: A 6-Year Retrospective Analysis
Introduction: An important category of IE, Non-nosocomial healthcare associated infective endocarditis (NNHCA-IE), has emerged over the last few decades and mostly seen among patients with multiple comorbidities and recurrent exposure to the healthcare setting. Through evaluation of temporal trends in IE cases and characterization of causative microorganisms, comorbidities and outcomes associated with IE at our facility, we aim to identify at risk individuals in an effort to prevent significant morbidity and mortality.
Study Design: A systematic chart review of adult patients was conducted identifying individuals meeting definite criteria for diagnosis of endocarditis at a single academic medical center from 2005-2010. Non-nosocomial healthcare associated infective endocarditis was defined as blood cultures positive in <48 hours of hospitalization in those receiving intensive medical therapy, presence of central catheter or presentation from a longterm care facility. Community Acquired IE included patients with blood cultures positive 48 hours after hospitalization without evidence of infection at the time of admission.
Results: Of 180 cases identified, approximately 106 met Modified Dukes Criteria for IE [NNHCA (n=60), Community Acquired (n=35), Nosocomial (n=11)]. At our facility, the types of IE did not differ by age, sex, or race. Enterococcus and MRSA infections were 13.2 (95% CI: 1.4 to 120.6) and 3.7 (95% CI: 1.1 to12.8) times more common in NNHCA IE cohort. Of 106 total cases, 35 (33%) of cases were attributed to central venous catheter related blood stream infections. Of 71 healthcare related cases, 35 (49%) were attributed to catheter related blood stream infections. None of the comorbidities reviewed were significantly associated with higher inpatient mortality. However, ESRD on hemodialysis, diabetes, hypertension, CAD, heart failure, intravenous drug use, smoking, and alcohol were found to be independent risk factors associated with NNHCA IE (p < 0.05). In forward stepwise multivariate logistic regression analysis, significant risk factors after adjusting for age, sex, and race, included ESRD (OR: 6.98; 95% CI:1.4-33.4) and hypertension (OR: 4.6; 95% CI:1.5-14.5).
Discussion: NNHCA IE was the most common IE subgroup seen in our facility. MRSA is the number one causative microorganism for all IE cases as well as for NNHCA IE. ESRD on hemodialysis and hypertension were identified as significant clinical risk factors associated with NNHCA IE.
Approximately 49% of healthcare related cases were directly attributed to central catheter related bloodstream infections. Inpatient mortality due to IE did not differ by age, sex, race or presence of any comorbidities evaluated.
- © 2013 by American Heart Association, Inc.