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Nosocomial enterococcal endocarditis: a serious hazard for hospitalized patients with enterococcal bacteraemia
Author(s) -
FernándezGuerrero M. L.,
Herrero L.,
Bellver M.,
Gadea I.,
Roblas R. F.,
De Górgolas M.
Publication year - 2002
Publication title -
journal of internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.625
H-Index - 160
eISSN - 1365-2796
pISSN - 0954-6820
DOI - 10.1046/j.1365-2796.2002.01061.x
Subject(s) - medicine , endocarditis , bacteremia , univariate analysis , enterococcus faecalis , incidence (geometry) , hazard ratio , infective endocarditis , surgery , staphylococcus aureus , antibiotics , multivariate analysis , microbiology and biotechnology , confidence interval , genetics , physics , optics , bacteria , biology
. Fernández‐Guerrero ML, Herrero L, Bellver M, Gadea I, Roblas RF, de Górgolas M (Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Spain). Nosocomial enterococcal endocarditis: a serious hazard for hospitalized patients with enterococcal bacteraemia. J Intern Med 2002; 252: 510–515. Objectives. Enterococci are a major leading cause of infectious endocarditis and also a common cause of hospital‐acquired bacteraemia, which is not believed to represent a serious hazard for the endocarditis. The incidence and risk factors for infectious endocarditis in patients with hospital‐acquired enterococcal bacteraemia is determined. Methods. Prospective analysis of 116 patients with enterococcal bacteraemia admitted to medical or surgical wards of a tertiary‐care, university affiliated hospital during a period of 5 years. Echocardiography was performed when indicated by clinical criteria. Results. Seventy‐five (61.4%) episodes were hospital‐acquired and 47 (38.5%) were community‐acquired. Most patients had one or more underlying chronic diseases and major abdominal (58.6%) or genitourinary (38.6%) surgery. Seventeen patients (14.6%) developed enterococcal endocarditis. By univariate analysis the risk factors associated with endocarditis were community‐acquired infection ( P 0.012); monomicrobial bacteraemia ( P 0.006); three or more positive blood cultures ( P < 0.001); underlying valvulopathy ( P < 0.001); presence of a prosthetic valve ( P < 0.001) and age ( P 0.012). Six patients (8%) developed nosocomial endocarditis. In this group of patients, three or more positive blood cultures ( P < 0.01), bacteraemia as a result of Enterococcus faecalis ( P 0.007); underlying valvulopathy ( P < 0.001) and presence of a prosthetic valve ( P < 0.001) were associated with endocarditis. By logistic regression, the presence of underlying valvulopathy and three or more positive blood cultures were associated with endocarditis (OR 21.0; CI 95% 1.65–26.9; P 0.019) . Conclusions. The risk of developing infectious endocarditis in patients with hospital‐acquired enterococcal bacteraemia is significant. Patients with underlying valvulopathy and three or more positive blood cultures with E. faecalis are prone to nosocomial enterococcal endocarditis.