Health Care-Associated Native Valve Endocarditis: Importance of Non-nosocomial Acquisition
Health Care-Associated Native Valve Endocarditis: Importance of Non-nosocomial Acquisition
复制标题
DOI：
10.7326/0003-4819-150-9-200905050-00004
复制
发表时间：
2009-05-05
影响因子：
39.2
通讯作者：
Fowler, Vance G., Jr.
中科院分区：
文献类型：
--
作者：
Benito, Natividad;Miro, Jose M.;Fowler, Vance G., Jr.
目的：比较社区相关、院内和非院内卫生保健相关的自然瓣膜心内膜炎的特征和结果。设计：前瞻性队列研究。背景：28个国家的61家医院。患者：从2000年6月到2005年8月参加ICE-PCS(国际心内膜炎前瞻性队列研究)的明确的自然瓣膜心内膜炎患者，无注射药物使用史。测量：临床和超声心动图结果，微生物学，并发症，并发症结果：1622例患者中有557例(34%)存在与医疗保健相关的自发性瓣膜心内膜炎(303例医院感染[54%]和254例非医院感染[46%])。金黄色葡萄球菌是卫生保健相关感染最常见的原因(医院内，47%；非医院内，42%；P=0.3)；高比例的患者有耐甲氧西林金黄色葡萄球菌(医院内，57%；非医院内，41%；P=0.014)。与医疗保健相关的自发性瓣膜心内膜炎患者接受心脏手术的人数较少(41%对51%的社区相关患者；P<；0.001)，但更多的前者患者死亡(25%对13%；P<；0.001)。多变量分析证实，与医疗保健相关的自然瓣膜心内膜炎相关的死亡率更高(发病率风险比，1.28[95%CI，1.02至1.59])。限制：患者在医院接受心脏手术治疗。结论：在非注射吸毒者中，超过1/3的天然瓣膜心内膜炎病例与医疗保健接触有关，非医院内感染很常见，尤其在美国。临床医生应该认识到，有广泛院外卫生保健接触的门诊患者发生心内膜炎的临床特征和结果与医院感染患者相似。主要资金来源：无。
Background: The clinical profile and outcome of nosocomial and non-nosocomial health care-associated native valve endocarditis are not well defined.Objective: To compare the characteristics and outcomes of community-associated and nosocomial and non-nosocomial health care-associated native valve endocarditis.Design: Prospective cohort study.Setting: 61 hospitals in 28 countries.Patients: Patients with definite native valve endocarditis and no history of injection drug use who were enrolled in the ICE-PCS (International Collaboration on Endocarditis Prospective Cohort Study) from June 2000 to August 2005.Measurements: Clinical and echocardiographic findings, microbiology, complications, and mortality.Results: Health care-associated native valve endocarditis was present in 557 (34%) of 1622 patients (303 with nosocomial infection [54%] and 254 with non-nosocomial infection [46%]). Staphylococcus aureus was the most common cause of health care-associated infection (nosocomial, 47%; non-nosocomial, 42%; P = 0.30); a high proportion of patients had methicillin-resistant S. aureus (nosocomial, 57%; non-nosocomial, 41%; P = 0.014). Fewer patients with health care-associated native valve endocarditis had cardiac surgery (41% vs. 51% of community-associated cases; P < 0.001), but more of the former patients died (25% vs. 13%; P < 0.001). Multivariable analysis confirmed greater mortality associated with health care-associated native valve endocarditis (incidence risk ratio, 1.28 [95% CI, 1.02 to 1.59]).Limitations: Patients were treated at hospitals with cardiac surgery programs. The results may not be generalizable to patients receiving care in other types of facilities or to those with prosthetic valves or past injection drug use.Conclusion: More than one third of cases of native valve endocarditis in non-injection drug users involve contact with health care, and non-nosocomial infection is common, especially in the United States. Clinicians should recognize that outpatients with extensive out-of-hospital health care contacts who develop endocarditis have clinical characteristics and outcomes similar to those of patients with nosocomial infection.Primary Funding Source: None.