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Published on: October 31, 2019
Hospital-acquired infective endocarditis during Covid-19 pandemic
Antonio Ramos-Martínez1, Ana Fernández-Cruz2, Fernando Domínguez3
1Unidad de Enfermedades Infecciosas (Medicina Interna), Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, IDIPHISA, Madrid, Spain.
Insights
The COVID-19 pandemic saw a significant rise in hospital-acquired infective endocarditis (HAIE) cases. Prioritizing catheter care and prompt infection treatment is crucial during outbreaks to reduce HAIE risks.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Critical Care Medicine
Background:
- The COVID-19 pandemic has significantly impacted hospital healthcare, particularly infection diagnosis and treatment.
- Hospital-acquired infective endocarditis (HAIE) is a severe, increasingly common complication of medical procedures.
Purpose of the Study:
- To assess if HAIE incidence increased during the initial COVID-19 epidemic phase (March-April 2020).
- To characterize the clinical presentation of HAIE cases during this period.
- To calculate the probability of HAIE using Poisson distribution.
Main Methods:
- Retrospective analysis of HAIE cases diagnosed during March-April 2020.
- Comparison of incidence rates with the preceding five years.
- Clinical data collection including patient history, procedures, causative agents, and outcomes.
Main Results:
- Four HAIE cases were diagnosed, with an incidence of 2/patient-month, significantly higher than the 0.3/patient-month observed in previous years (p=0.033).
- Etiologies included Enterococcus faecalis (2), Staphylococcus aureus (1), and Candida albicans (1).
- Common sources included central venous catheters, peripheral venous catheters, and sternal wound infections. Two patients died.
Conclusions:
- The incidence of HAIE was significantly elevated during the COVID-19 pandemic.
- Optimal catheter care and prompt treatment of local infections are essential to mitigate HAIE risk during outbreaks.
Background:
The COVID pandemic has had a major impact on healthcare in hospitals, including the diagnosis and treatment of infections. Hospital-acquired infective endocarditis (HAIE) is a severe complication of medical procedures that has shown a progressive increase in recent years.
Objectives:
To determine whether the incidence of HAIE during the first two months of the epidemic (March-April 2020) was higher than previously observed and to describe the clinical characteristics of these cases. The probability of the studied event (HAIE) during the study period was calculated by Poisson distribution.
Results:
Four cases of HAIE were diagnosed in our institution during the study period. The incidence of HAIE during the study period was 2/patient-month and 0.3/patient-month during the same calender months in the previous 5 years (p=0.033). Two cases presented during admission for COVID-19 with pulmonary involvement treated with methylprednisolone and tocilizumab. The other two cases were admitted to the hospital during the epidemic. All cases underwent central venous and urinary catheterization during admission. The etiology of HAIE was Enterococcus faecalis (2 cases), Staphylococcus aureus and Candida albicans (one case each). A source of infection was identified in three cases (central venous catheter, peripheral venous catheter, sternal wound infection, respectively). One patient was operated on. Two patients died during hospital admission.
Conclusions:
The incidence of HAIE during COVID-19 pandemic in our institution was higher than usual. In order to reduce the risk of this serious infection, optimal catheter care and early treatment of every local infection should be prioritized during coronavirus outbreaks.
Related Concept Videos
01:25Endocarditis I: Introduction
01:25Endocarditis II: Clinical Features of Infective Endocarditis
01:18Endocarditis III: Medical Management
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01:26Healthcare Associated Infections I: Iatrogenic, Exogenic and Endogenic
HAIs significantly increase the cost of health care. Extended stays in healthcare institutions, increased disability, increased costs of medications, including specialized antibiotics, and prolonged recovery times add to the patient's expenses and the healthcare institution and funding bodies.
01:14Myocarditis III: Medical Management