• Jorge Calderón Parra, Daniel De Castro-Campos, Muñoz GarcíaPatriciaPClinical Microbiology and Infectious Diseases Department, Hospital Gregorio Marañón, Madrid, Spain., Maria Olmedo Samperio, Mercedes Marín Arriaza, Aristides De Alarcón, Encarnación Gutierrez-Carretero, Maria Carmen Fariñas Alvarez, Jose María Miró Meda, Miguel Ángel Goneaga Sanchez, Raquel Rodriguez García, Guillermo Ojeda Burgos, Zeltia Valcarce-Gonzalez, Antonio Ramos-Martinez, and Spanish Collaboration on Infectious Endocarditis Group (GAMES) investigators.
• Infectious Diseases Unit, Internal Medicine Department, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain.
• Eur. J. Intern. Med. 2021 Oct 1; 92: 71-78.

BackgroundInfective endocarditis (IE) due to non-HACEK bacilli (Haemophilus species, Actinobacillus, Cardiobacterium, Eikenella, or Kingella) is uncommon and poorly described. The objectives of this study were to describe non-HACEK Gram-Negative Bacilli (GNB) IE cases and compare characteristic of IE produced by Enterobacterales and non-fermenting (NF) GNB.MethodsFrom January 2008 to December 2018, 3910 consecutive patients with definitive IE diagnosis, defined with Modified Duke criteria, either clinical or pathological criteria (e.g. demonstration of non-HACEK GNB in valve culture)were prospectively included.ResultsA total of 104 IE cases were caused by non-HACEK GNB (2.6%). Compared to IE due to other microorganisms (excluding HACEK GNB), patients with non-HACEK GNB IE presented with higher age (71 years [IQR 62-78] vs 68 years [IQR: 57-77]; p = 0.026), higher proportion of women (52% vs 31.5%, p < 0.001), higher Charlson Index (5 [IQR: 4-8] vs 4 [IQR 3-7], p = 0.003) and higher in-hospital mortality (36.5% vs 27.1%, p = 0.034). Enterobacterales cases were more frequently associated with genitourinary focus (32.8% vs 5.0%, p = 0.001). NFGNB endocarditis more frequently affected right valves (20.0% vs. 6.3%, p = 0.033), had more common healthcare-related acquisition (67.5% vs. 43.7%, p = 0.030) and venous catheter as focus (40.0% vs. 17.2%, p = 0.019). In the multivariant model, factors related with hospital mortality were: age (OR 1.05, 95%CI 1.00-1.09, p = 0.042), prosthetic valve (OR 2.31, 95%CI 0.90-5.88, p = 0.080), and not performing surgery when indicated (OR 3.60, 95%CI 1.17-11.05, p = 0.025).Patients treated with quinolone combination had lower mortality (OR 0.29; 95%CI 0.09-0.96; p = 0.043).ConclusionNon-HACEK GNB IE is a rare infection characterized by affecting elderly patients with high comorbidity, nosocomial acquisition and unfavorable outcome. Age, prosthetic valve and not performing surgery when indicated are associated with mortality.Copyright © 2021. Published by Elsevier B.V.

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