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Epidemiological and bacteriological profile of community-acquired infective endocarditis

Abstract number: P1822

Slavcovici A., Bedeleanu D., Barsan M., Hagau N., Radulescu A., Zanc V., Tatulescu D., Rotar A., Cismaru C., Dicea A., Marcu C., Iubu R., Cioara A., Jianu C., Carstina D.

Background: The epidemiological and bacteriological profiles of infective endocarditis have changed due to longevity, more invasive procedures and immunity disorders.

Objectives: To describe community-acquired infective endocarditis (CA-IE) according to host characteristics and evaluation of the microbiological spectrum.

Methods: Design: prospective study performed in the Cluj-Napoca Teaching Hospital of Infectious Diseases between 1998 and 2007. According to modified Duke criteria 186 definite and probable CA-IE were studied. Bacteriologic assessment was performed using the automatic system BactT/Alert and resistance patterns were determined with API 20E, Api 20NE and ATB automatic methods under CLSI 2006 standards. EPIInfo 6 was used for statistical analysis.

Results: CA-IE was diagnosed in 186 patients (73%) of 254 consecutive cases of infective endocarditis. Most of the cases were native valve endocarditis (153 cases – 82%). Demographic characteristics: age range 7–89 years (median 52 yrs), sex ratio M:F 1.66:1. Immunity disorders were found in 43 cases (23%) including: diabetes mellitus, chronic hepatitis, kidney failure, malignancies, corticosteroid treatment, asplenia. The elderly of more than 60 years represented 30.6% (57) of all cases. Presumed portal of entry represented by poor oral hygiene and periodontal disease, gastrointestinal and urinary tract disorders was identified in 102 patients (55%). The bacteriological profile was dominated by streptococci (20.4% – 38 strains), from which 21% were group C and D. The other common causes were represented by: staphylococci – 29 strains (15.6%), enterococci – 15 isolates (8%) and Gram-negative rods – 8 strains (4.3%). In the elderly the most frequent isolates were streptococci and enterococci. We found significant correlation between digestive or urinary portal of entry and enterococcal aetiology (OR 8; 95% CI, 1.95–32.8) and for periodontal disease and oral streptococci (OR 115; 95% CI, 15.6–2367). Almost all isolates were susceptible to common antibiotics except 10 strains of Staphylococcus aureus and coagulase-negative staphylococci that were meticillin resistant. Glycopeptide resistance was never found in these strains.

Conclusion: Underlying diseases and presumed portal of entry are of utmost importance in diagnosing and management of CA-IE. The microbiological profile sustains the usefulness of guideline recommendations.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Barcelona, Spain
Presentation type:
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