Non-HACEK Gram-negative bacillus endocarditis - 31/03/19

Endocardite à bacilles à Gram négatif non HACEK

Doi : 10.1016/j.medmal.2019.03.013

M. Ertugrul Mercan ^a, F. Arslan ^b,^⁎ , S. Ozyavuz Alp ^c, A. Atilla ^d, D. Seyman ^e, G. Guliyeva ^f, B. Kayaaslan ^g, S. Sari ^h, B. Mutay Suntur ⁱ, B. Isik ^b, A. Mert ^j
^a Department of Cardiology, Faculty of Medicine, Istanbul Acibadem University, Istanbul, Turkey
^b Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
^c Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
^d Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
^e Department of Infectious Diseases and Clinical Microbiology, Health Sciences University, Antalya Education and Training Hospital, Antalya, Turkey
^f Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, İzmir, Turkey
^g Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
^h Department of Intensive Care Unit, Health Sciences University, Turkiye Yüksek İhtisas Taining and Research Hospital, Ankara, Turkey
ⁱ Department of Infectious Disease and Clinical Microbiology, Health Sciences University, Adana Numune Taining and Research Hospital, Adana, Turkey
^j Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey

^⁎Corresponding author. Ist. Medeniyet Univ, Goztepe EA Hastanesi, Dr. Erkin caddesi, 34722 Kadıkoy Istanbul, Turkey.Ist. Medeniyet Univ, Goztepe EA Hastanesi, Dr. Erkin caddesiKadıkoy Istanbul34722Turkey

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Highlights

•	Data on non-HACEK Gram-negative infective endocarditis is limited to case reports and case series.
•	Clinicians may encounter non-HACEK Gram-negative infective endocarditis in medical wards mostly because of the high number of intravascular interventions performed and elderly patients treated.
•	While environmental pathogens are pan-susceptible to antimicrobials, Klebsiella species endocarditis is associated with an increased risk of drug resistance.

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Abstract

Patients and methods

Retrospective analysis of clinical data using 26 diagnosed non-HACEK Gram-negative infective endocarditis cases from nine hospitals in Turkey.

Results

Mean age of patients was 53 (28–84) years, with a 23% case fatality. Nineteen (73%) of the 26 patients had at least one predisposing factor. The presence of a central venous catheter was the most common predisposing factor (7/26 patients). Pseudomonas aeruginosa (7/26 patients) and Escherichia coli (7/26 patients) were the most common pathogens. The median duration of the antibiotic therapy was 42 days (range 3–84 days). Surgical procedures were performed in 10 patients. The case fatality was similar in patients who did or did not undergo surgery (20% vs. 25%).

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Résumé

Patients et méthodes

Analyse rétrospective des données cliniques sur 26 cas d’endocardite infectieuse à bacilles à Gram négatif non HACEK dans neuf hôpitaux turcs.

Résultats

L’âge moyen de la cohorte de patients était de 53 ans (28–84 ans). La létalité était de 23 %. Parmi les 26 patients, 19 (73 %) avaient au moins un facteur prédisposant. La présence d’un cathéter veineux central était le facteur prédisposant le plus fréquent (7/26 patients). Pseudomonas aeruginosa (7/26 patients) et Escherichia coli (7/26 patients) étaient les pathogènes les plus fréquents. La durée médiane de l’antibiothérapie était de 42jours (3 à 84jours). Des interventions chirurgicales ont été réalisées chez 10 patients. La létalité était similaire chez les patients ayant ou non subi une intervention chirurgicale (20 % vs 25 %).

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Keywords : Endocarditis, Catheterization, Gram-negative bacteria

Mots clés : Endocardite, Cathétérisme, Bactéries à Gram négatif