A Comparison of Hospital and Community-Acquired Infective Endocarditis Sharon C. A. Chen, MBBS, FRACP, Dominic E. Dwyer, MBBS, BSc(Med), FRACP, and Tania C. Sorrell, BS, FRACP

The epidemiology, clinical features, microbiology and outcome of 30 episodes of nosocomial endocarditis occurring over a l&year period were reviewed and compared with 148 cases of community-acquired endocarditis. Twenty-eight patients (93%) had been in hospital for >l week and 10 patients (33%) for >1 month when they devdoped endocarditis. Left-sided infection was most frequent; only 3 cases involved the tricuspid vaive. Compared with community-acquired infection, patients tended to be oider, had a greater incidence of congestive cardiac failure (p = 0.001) or hypotendon (p = 0.0008) at presentation and were more likely to have bacteremia after an invasive procedure (83 VI 31%; p l week, with 10 developingendocarditis after 1 month in the hospital. Underlying native valve abnormalities were present in 11 of 25 nosocomialcasescomparedwithin 56 of 112 community-acquired cases. Five patients (17%) with hospital-acquired infection had prosthetic cardiac valves in situ compared with 29% with nonnosocomialendocarditis (p = 0.16). Left-sided endocarditis was most frequent; 17 patients had aortic and 13 mitral valve infection. Tricuspid valve involvement occurred in 3 patients; all the episodeswere related to infected intravascular devices. No patient had underlying valve abnormalities. c#niccll aspects: Clinical features at presentation, which were similar to thosein patients with communityacquired endocarditis, included fever in 23 cases(77%), and embolic phenomena,including neurologic complications, in 20 (67%). Twenty-three patients developeda new or changing murmur. However, congestivecardiac failure and hypotension were more frequent in patients with nosocomialendccarditis; the former occurred in 16 of 30 (53%) vs 34 of 148 (23%) episodes(p = O.OOl), and the latter in 8 of 30 (27%) vs 12 of 148 (9%) (p = 0.008). Twelve patients (40%) presented to the hospital within 7 days of the onset of symptoms compared with 43 (29%) with community-acquired endocarditis. Two patients with culture-negative endocarditis presentedwith fever, signs of embolic phenomena,and new murmurs. In 7 cases,the diagnosisof endocarditis was not obtained until >l month in the hospital, and in 2 patients only at postmortem. Sovce of Meetbm A source of bacteremia was clinically apparent in 25 episodes (83%) compared with in 46 (31%) of community-acquired infection (p 60 years died compared with 7 of 14 patients aged

A comparison of hospital and community-acquired infective endocarditis.

The epidemiology, clinical features, microbiology and outcome of 30 episodes of nosocomial endocarditis occurring over a 13-year period were reviewed ...
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