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[Nosocomial infective endocarditis in patients without hear prosthesis]
P Llinares Mondéjar1, M Núñez Fernández, L Cordero Lorenzana
1Unidad de Enfermedades Infecciosas, Hospital Juan Canalejo, La Coruña.
Revista Clinica Espanola
|May 15, 1998
Summary
Nosocomial endocarditis (NE) is a significant complication of hospital-acquired bacteremia. This study highlights Staphylococcus spp. as a key cause, with intravascular catheters as a major risk factor, and notes similar mortality rates to community-acquired endocarditis.
Area of Science:
- Infectious Diseases
- Cardiology
- Critical Care Medicine
Background:
- Infective endocarditis is a serious complication of nosocomial bacteremia, carrying a high mortality rate.
- Understanding the characteristics of hospital-acquired endocarditis is crucial for improving patient outcomes.
Purpose of the Study:
- To determine the clinical and microbiological features of nosocomial endocarditis (NE).
- To analyze risk factors, causative microorganisms, and outcomes of NE in a general hospital setting.
Main Methods:
- A retrospective study of 21 patients diagnosed with NE between 1990 and 1995, excluding those with prosthetic valves.
- Diagnosis followed Durack's criteria; data on patient demographics, microbial sources, affected valves, diagnostic imaging, and treatment were collected.
Main Results:
- NE constituted 12% of all endocarditis cases. Intravascular catheters were the source in 85.7% of NE cases, with Staphylococcus aureus being the most common pathogen (62%).
- Left-sided valve involvement was predominant (76.2%). Transesophageal echocardiography improved diagnosis in cases where transthoracic echocardiography was inconclusive.
- Surgery was indicated for refractory congestive heart failure. The overall mortality rate was 28.5%, comparable to community-acquired endocarditis.
Conclusions:
- Nosocomial endocarditis, particularly excluding prosthetic valve cases, represents a significant clinical entity.
- Staphylococcus species are key etiological agents, and intravascular catheters are a primary risk factor. Left-sided valve involvement is common.
- Transesophageal echocardiography is highly valuable for diagnosis. The mortality rate observed was similar to community-acquired endocarditis, contrary to some literature findings.