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Infective Endocarditis Caused by Non-HACEK Gram-Negative Bacteria, a Registry-Based Comparative Study.
Jasmina Al Janabi1, Mohammed El Noaimi1, Torgny Sunnerhagen1,2
1Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
Open Forum Infectious Diseases
|March 10, 2025
Summary
Infective endocarditis (IE) caused by non-HACEK gram-negative bacteria (nHGNB) is uncommon. While Pseudomonas aeruginosa and Serratia marcescens are now considered typical pathogens, their inclusion did not improve diagnostic criteria performance.
Area of Science:
- Infectious Diseases
- Microbiology
- Cardiology
Background:
- Infective endocarditis (IE) caused by non-HACEK gram-negative bacteria (nHGNB) is rare.
- The 2023 Duke-ISCVID criteria now list Pseudomonas aeruginosa and Serratia marcescens as typical IE pathogens.
- This study investigates the implications of this classification and the characteristics of nHGNB IE.
Purpose of the Study:
- To assess the risk of IE in patients with nHGNB bacteremia.
- To analyze the features of IE caused by nHGNB species.
- To evaluate the impact of classifying P. aeruginosa and S. marcescens as typical IE pathogens on diagnostic criteria.
Main Methods:
- Retrospective analysis of nHGNB IE cases from the Swedish Registry of Infective Endocarditis (SRIE) (2008-2023).
- Comparison of IE cases with control episodes of nHGNB bacteremia.
- Evaluation of Duke-ISCVID criteria performance for nHGNB IE.
Main Results:
- 114 episodes of nHGNB IE identified (1.5% of all IE cases).
- Escherichia coli was the most frequent cause (28%), followed by P. aeruginosa (13%) and Klebsiella (9%).
- P. aeruginosa and Serratia were more prevalent in IE than bacteremia, but Duke-ISCVID criteria performance did not improve.
Conclusions:
- P. aeruginosa and Serratia are more common in IE than bacteremia.
- The classification of P. aeruginosa and Serratia as typical IE pathogens did not enhance the Duke-ISCVID criteria's effectiveness.
- nHGNB IE is associated with frequent underlying diseases and higher mortality compared to streptococcal IE.
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