• J M Lomas, F J Martínez-Marcos, A Plata, R Ivanova, J Gálvez, J Ruiz, J M Reguera, M Noureddine, J de la Torre, A de Alarcón, and Grupo Andaluz para el Estudio de las Infecciones Cardiovasculares (Andalusian Group for the Study of Cardiovascular Infections) at the Sociedad Andaluza de Enfermedades Infecciosas (SAEI).
• Department of Infectious Diseases, Hospital General Juan Ramón Jiménez, Huelva, Spain. jlomascabezas@yahoo.es
• Clin. Microbiol. Infect. 2010 Nov 1;16(11):1683-90.

AbstractInvasive medical technology has led to an increase in the incidence of healthcare-associated infective endocarditis (HAIE). A prospective multicentre cohort study was conducted at seven hospitals in Andalusia, Spain, to establish the characteristics of HAIE and to compare them with those of community-acquired infective endocarditis (CAIE). HAIE was defined as either infective endocarditis (IE) manifesting >48 h after admission to hospital, or IE associated with a significant invasive procedure performed in the 6 months before diagnosis. Seven hundred and ninety-three cases of IE were investigated, and HAIE accounted for 127 (16%). As compared with patients with CAIE, patients with HAIE were older (60.1 ± 14.4 years vs. 53.6 ± 17.5 years) and had more comorbidities (Charlson index 3.3 ± 2.3 vs. 1.8 ± 2.3) and staphylococcal infections (58.3% vs. 24.8%). Vascular manipulation was the main cause of bacteraemia responsible for HAIE (63%). Peripheral vein catheter-associated bacteraemia accounted for 32.8% of the catheter-related bacteraemias. In-hospital mortality (44.9% vs. 24.2%) was higher in the HAIE group. Septic shock (OR 2.2, 95% CI 2.9-30.2) and surgery not performed because of high surgical risk (OR 1.6, 95% CI 1.2-20) were independent predictors of mortality in HAIE. The present study demonstrates that HAIE is a growing health problem associated with high mortality. Careful management of vascular devices is essential to minimize the risk of bacteraemias leading to HAIE.

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