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Hospital practices influence the pattern of infective endocarditis
D E Dwyer1, S C Chen, E J Wright
1Centre for Infectious Diseases and Microbiology, University of Sydney, ICPMR, Westmead Hospital, NSW.
The Medical Journal of Australia
|June 6, 1994
Summary
Infective endocarditis in teaching hospitals is often acquired in the hospital or transferred between hospitals, with Staphylococcus aureus being a common cause. Community-acquired cases show different causative organism patterns, particularly in intravenous drug users.
Area of Science:
- Infectious Diseases
- Cardiology
- Hospital Epidemiology
Background:
- Infective endocarditis (IE) is a serious infection affecting heart valves.
- Understanding the factors influencing IE etiology in different healthcare settings is crucial for effective management.
Purpose of the Study:
- To identify the key factors contributing to infective endocarditis within a major teaching hospital setting.
- To analyze the causative organisms, clinical features, and outcomes of IE episodes.
Main Methods:
- A retrospective review of clinical records was conducted for patients diagnosed with endocarditis.
- Standard case definitions were used to identify episodes, causative organisms, clinical presentations, and patient outcomes.
- Data spanned from 1979 to 1992 at Westmead Hospital, Sydney.
Main Results:
- 193 episodes of IE were identified between 1979 and 1992.
- Staphylococcus aureus (43%) and viridans streptococci (29%) were the most common causative organisms.
- Nosocomial acquisition or inter-hospital transfer accounted for 83 episodes, predominantly caused by S. aureus (58%).
- Community-acquired IE showed a higher prevalence of viridans streptococci (37%) compared to S. aureus (25%), with a notable proportion in intravenous drug users.
Conclusions:
- The etiology of endocarditis in large teaching hospitals is significantly influenced by nosocomial infections and inter-hospital transfers.
- These factors lead to a different etiological profile compared to community-acquired endocarditis.
- Understanding these differences is vital for targeted prevention and treatment strategies.