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HACEK group endocarditis at the Riyadh Armed Forces Hospital
N el Khizzi1, S A Kasab, A O Osoba
1Division of Microbiology, Armed Forces Hospital, Riyadh, KSA.
The Journal of Infection
|January 1, 1997
Summary
HACEK endocarditis, caused by fastidious Gram-negative organisms, is rare but treatable. Prompt diagnosis and appropriate antibiotic therapy, including amoxycillin or ciprofloxacin, lead to excellent patient outcomes.
Area of Science:
- Infectious Diseases
- Microbiology
- Cardiology
Background:
- The HACEK group (Haemophilus spp., Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, Kingella spp.) comprises rare causes of infective endocarditis.
- This study investigates HACEK endocarditis cases in Saudi patients, focusing on clinical presentation, predisposing factors, and diagnostic methods.
Observation:
- Six cases of endocarditis caused by Cardiobacterium hominis and Actinobacillus actinomycetemcomitans were identified between 1990 and 1994.
- Predisposing factors included prosthetic heart valves, structural heart abnormalities, and dental/periodontal disease.
- Microscopic and cultural characteristics of the causative organisms were detailed.
Findings:
- HACEK endocarditis demonstrated a very good prognosis with high rates of clinical and bacteriological cure using antibiotic therapy.
- Antibiotic sensitivity patterns varied; while not all isolates were sensitive to penicillin/aminoglycosides, all were susceptible to amoxycillin, cefuroxime, ceftriaxone, and ciprofloxacin.
- Diagnosis requires a high index of suspicion for fastidious Gram-negative coccobacilli not growing on MacConkey agar.
Implications:
- Empiric therapy with second-generation cephalosporins or ciprofloxacin is recommended for suspected HACEK endocarditis pending sensitivity results.
- Prolonged antibiotic treatment (4-6 weeks) is crucial for achieving favorable outcomes.
- The findings underscore the importance of considering HACEK organisms in endocarditis cases and highlight effective therapeutic strategies.