016 HEALTH CARE-ASSOCIATED INFECTIVE ENDOCARDITIS

Abstract

Background: Infective endocarditis (IE) from different causative pathogens differ with regards to prognosis. We looked at predictive factors for different pathogens in a series of 386 patients admitted to two Copenhagen tertiary centres from 2002 to 2008, including differences in patients with native valve (NVE) or prosthetic IE, stratified by time from surgery (<3 months = early PVE or 3 months = late PVE). Methods: The study population consisted of 439 patients, excluding IV drug users (N = 22), PM endocarditis (N = 20), and recurrent IE (N = 11). Data is presented as number (%) and differences were tested by c2test. Predictive factors for individual pathogens were analysed by multivariate logistic regression modelling. Results: Median age (25th and 75th percentile) was 65 (56 75) and 113 (29%) were female. The prevalence of known risk factors for IE were: early PVE 18 (5%), late PVE 79 (20%), diabetes 34 (9%), history of cancer 38 (10%), renal dysfunction 57 (15%) and immunosuppression 36 (10%). Causative pathogen were Viridans group Streptococcus 120 (31%), Staphylococcus aureus 80 (21%), enterococci 66 (17%), Coagulase-negative staphylococci 32 (8%), other 44 (11%) and culture negative 44 (11%). Viridans group Streptococcus IE was associated with NVE (OR = 3.8, 95% CI: 1.9 7.4) and was infrequent in patients with renal dysfunction (OR = 0.33, 0.13 0.79). Enterococcus IE was related to age (OR = 1.3, 1.2 1.5 per 5 years) and frequent in patients with renal dysfunction (OR = 4.2, 2.0 8.9). Coagulase-negative Staphylococcus IE was frequent in PVE (OR = 4.5, 2.0 10.1). Culture Negative IE was frequently associated with PVE (OR = 2.6, CI: 1.2 5.4) and younger age (OR = 0.8, 0.7 0.9). Rare pathogens, grouped as ‘other’ was associated with younger age (OR = 0.8, 0.7 0.9 per 5 years) and less frequent in patients with renal dysfunction (OR = 0.45, 0.23 0.90). No independent predictors of Staphylococcus aureus IE were identified (IV drug users excluded). No differences in the pathogens associated with early PVE and late PVE could be identified. Conclusions: Viridans group streptococci are not common in patients with prosthetic heart valves, whereas coagulase-negative staphylococci and culture negative IE were more common in this group. Enterococcus IE are associated with increasing age. Considerable variation in the clinical appearance of IE and risk factors associated with causal pathogens underline the continuing diagnostic challenge of IE.