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HACEK INFECTIVE ENDOCARDITIS: CHARACTERISTICS AND OUTCOMES FROM A LARGE, MULTI-NATIONAL COHORT
Autor
Chambers, Stephen T.
Murdoch, David
Morris, Arthur
Holland, David
Pappas, Paul
Almela, Manel
Fernández-Hidalgo, Nuria
Almirante, Benito
Bouza, Emilio
Forno, Davide
Rio, Ana del
Hannan, Margaret M.
Harkness, John
Kanafani, Zeina A.
Lalani, Tahaniyat
Lang, Selwyn
Raymond, Nigel
Read, Kerry
Vinogradova, Tatiana
Woods, Christopher W.
Wray, Dannah
Corey, G. Ralph
Chu, Vivian H.
International Collaboration on Endocarditis Prospective Cohort Study (ICE-PCS) Investigators
Murdoch, David
Morris, Arthur
Holland, David
Pappas, Paul
Almela, Manel
Fernández-Hidalgo, Nuria
Almirante, Benito
Bouza, Emilio
Forno, Davide
Rio, Ana del
Hannan, Margaret M.
Harkness, John
Kanafani, Zeina A.
Lalani, Tahaniyat
Lang, Selwyn
Raymond, Nigel
Read, Kerry
Vinogradova, Tatiana
Woods, Christopher W.
Wray, Dannah
Corey, G. Ralph
Chu, Vivian H.
International Collaboration on Endocarditis Prospective Cohort Study (ICE-PCS) Investigators
Afiliación
University of Otago. Christchurch and Christchurch Hospital. Department of Pathology. Christchurch, New Zealand.
University of Otago. Christchurch and Christchurch Hospital. Department of Pathology. Christchurch, New Zealand.
Auckland City Hospital. Microbiology Laboratory. Auckland, New Zealand.
Middlemore Hospital. Microbiology Laboratory. Auckland, New Zealand.
Duke University Medical Centre. Duke Clinical Research Institute. Durham, NC, USA.
University of Barcelona. Hospital Clinic. IDIBAPS. Department of Microbiology. Barcelona, Spain.
Hospital Universitari Vall d’Hebron. Infectious Diseases Department. Barcelona, Spain.
Hospital Universitari Vall d’Hebron. Infectious Diseases Department. Barcelona, Spain.
Hospital General Universitario Gregorio Marañón. Clinical Microbiology and Infectious Diseases Service. Madrid, Spain.
Maria Vittoria Hospital. Cardiology Department. Torino, Italy.
University of Barcelona. Hospital Clinic. IDIBAPS. Department of Clinical Medicine, Infectious and Tropical Diseases. Barcelona, Spain.
Mater Hospitals. Department of Medical Microbiology. Dublin, Ireland.
St. Vincent’s Hospital. Department of Microbiology. Sydney, NSW, Australia.
American University of Beirut. Division of Infectious Diseases. Beirut, Lebanon.
Uniformed Services University. Infectious Disease Clinical Research Program. Bethesda, MD, USA.
Middlemore Hospital. Department of Microbiology. Auckland, New Zealand.
Wellington Hospital. Department of Infectious Diseases. Wellington, New Zealand.
North Shore Hospital. Department of Infectious Diseases. Auckland, New Zealand.
Russian Medical State University. Institute of Experimental Cardiology. Moscow, Russia.
VA Medical Centre. Department of Medicine. Durham, NC, USA.
Medical University of South Carolina. Infectuous Disease Division. Charleston, SC, USA.
Duke University Medical Center. Infectious Diseases. Durham, NC, USA.
Duke University Medical Center. Durham, NC, USA.
University of Otago. Christchurch and Christchurch Hospital. Department of Pathology. Christchurch, New Zealand.
Auckland City Hospital. Microbiology Laboratory. Auckland, New Zealand.
Middlemore Hospital. Microbiology Laboratory. Auckland, New Zealand.
Duke University Medical Centre. Duke Clinical Research Institute. Durham, NC, USA.
University of Barcelona. Hospital Clinic. IDIBAPS. Department of Microbiology. Barcelona, Spain.
Hospital Universitari Vall d’Hebron. Infectious Diseases Department. Barcelona, Spain.
Hospital Universitari Vall d’Hebron. Infectious Diseases Department. Barcelona, Spain.
Hospital General Universitario Gregorio Marañón. Clinical Microbiology and Infectious Diseases Service. Madrid, Spain.
Maria Vittoria Hospital. Cardiology Department. Torino, Italy.
University of Barcelona. Hospital Clinic. IDIBAPS. Department of Clinical Medicine, Infectious and Tropical Diseases. Barcelona, Spain.
Mater Hospitals. Department of Medical Microbiology. Dublin, Ireland.
St. Vincent’s Hospital. Department of Microbiology. Sydney, NSW, Australia.
American University of Beirut. Division of Infectious Diseases. Beirut, Lebanon.
Uniformed Services University. Infectious Disease Clinical Research Program. Bethesda, MD, USA.
Middlemore Hospital. Department of Microbiology. Auckland, New Zealand.
Wellington Hospital. Department of Infectious Diseases. Wellington, New Zealand.
North Shore Hospital. Department of Infectious Diseases. Auckland, New Zealand.
Russian Medical State University. Institute of Experimental Cardiology. Moscow, Russia.
VA Medical Centre. Department of Medicine. Durham, NC, USA.
Medical University of South Carolina. Infectuous Disease Division. Charleston, SC, USA.
Duke University Medical Center. Infectious Diseases. Durham, NC, USA.
Duke University Medical Center. Durham, NC, USA.
Resumen en ingles
The HACEK organisms (Haemophilus species, Aggregatibacter species, Cardiobacterium hominis, Eikenella corrodens, and Kingella species) are rare causes of infective endocarditis (IE). The objective of this study is to describe the clinical characteristics and outcomes of patients with HACEK endocarditis (HE) in a large multi-national cohort. Patients hospitalized with definite or possible infective endocarditis by the International Collaboration on Endocarditis Prospective Cohort Study in 64 hospitals from 28 countries were included and characteristics of HE patients compared with IE due to other pathogens. Of 5591 patients enrolled, 77 (1.4%) had HE. HE was associated with a younger age (47 vs. 61 years; p<0.001), a higher prevalence of immunologic/vascular manifestations (32% vs. 20%; p<0.008) and stroke (25% vs. 17% p = 0.05) but a lower prevalence of congestive heart failure (15% vs. 30%; p = 0.004), death in-hospital (4% vs. 18%; p = 0.001) or after 1 year follow-up (6% vs. 20%; p = 0.01) than IE due to other pathogens (n = 5514). On multivariable analysis, stroke was associated with mitral valve vegetations (OR 3.60; CI 1.34-9.65; p<0.01) and younger age (OR 0.62; CI 0.49-0.90; p<0.01). The overall outcome of HE was excellent with the in-hospital mortality (4%) significantly better than for non-HE (18%; p<0.001). Prosthetic valve endocarditis was more common in HE (35%) than non-HE (24%). The outcome of prosthetic valve and native valve HE was excellent whether treated medically or with surgery. Current treatment is very successful for the management of both native valve prosthetic valve HE but further studies are needed to determine why HE has a predilection for younger people and to cause stroke. The small number of patients and observational design limit inferences on treatment strategies. Self selection of study sites limits epidemiological inferences.
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