Clinical epidemiology and microbiological spectrum of nosocomial endocarditis
Abstract number: P1823
Slavcovici A., Radulescu A., Bedeleanu D., Hagau N., Barsan M., Tatulescu D., Zanc V., Dicea A., Cioara A., Rotar A., Jianu C., Carstina D.
Background: The epidemiological features of infective endocarditis have changed during the last decades because of an increase in placement of prosthetic valves and exposure to invasive procedures.
Objectives: To assess clinical epidemiology and microbiological spectrum of nosocomial endocarditis (NE) defined according to Duke modified criteria.
Methods: Design: prospective study performed in a teaching hospital of infectious diseases.
During the study period (19982007) 46 cases of NE were admitted. NE was defined according to accepted definition: endocarditis associated with invasive procedures performed in hospital during the 8 week period before the onset of the disease or endocarditis occurring >48 h after admission.
Results: Definite NE was present in 46 patients (18%) of 254 consecutive cases of infective endocarditis, age range: 2172 years (median 49 yrs), sex ratio M:F was 3:1. Comorbities that predispose to infection were found in 14 patients (30.4%): 4 cases diabetes mellitus, 5 cases chronic kidney failure, 5 cases immunosuppressive conditions. Cardiac risk factor represented by prosthetic valves was found in 21 cases 45.6%. NE was documented based on bacteraemia related to surgical or medical procedures: 22 cases (47.8%) after cardiovascular procedures (less than 1 year after valve placement, intravascular devices, pacemakers implants); 13 cases (28.3%) after genitourinary procedures; 5 cases (10.9%) after gastrointestinal surgical interventions and procedures; 6 cases (13%) after other invasive procedures (endoscopy and ORL procedures). Thirty five percent of NE (16 cases) occurred within the first year after valve implantation (early prosthetic valve endocarditis). The most commonly isolated organism was staphylococci 21 cases (45.6%), 18 strains Staphylococcus aureus and 3 strains coagulase negative staphylococci. Other isolated microorganisms were: enterococci (8 cases 17.4%), Gram-negative rods (5 cases 10.9%), uncommon bacteria (2 cases 4.3%). No vancomycin resistant Gram-positive cocci were isolated. Twenty-three patients (50%) had unfavourable outcome: 4 deaths and 19 complicated cases referred for surgical treatment.
Conclusions: Intracardiac, intravascular devices and genitourinary tract procedures represented the most important risk factors for nosocomial bacteraemia. The leading cause of NE was staphylococci bacteraemia. Cardiothoracic surgery is needed in a high proportion of NE.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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