Research article

Non-nosocomial healthcare-associated infective endocarditis in Taiwan: an underrecognized disease with poor outcome

Kuan-Sheng Wu¹, Susan SJ Lee^1,2, Hung-Chin Tsai^1,2, Shue-Ren Wann¹, Jui-Kuang Chen¹, Cheng-Len Sy¹, Yung-Hsin Wang¹, Yu-Ting Tseng¹ and Yao-Shen Chen^1,2,3*

• * Corresponding author: Yao-Shen Chen yschen@vghks.gov.tw

Author Affiliations

¹ Divison of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung 813, Taiwan

² School of Medicine, National Yang-Ming University, No.155, Section 2, Linong Street, Taipei 112 Taiwan

³ Graduate Institute of Environmental Education, National Kaohsiung Normal University, No.116, Heping 1st Road, Kaohsiung 802, Taiwan

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BMC Infectious Diseases 2011, 11:221 doi:10.1186/1471-2334-11-221

Published: 17 August 2011

Abstract

Background

Non-nosocomial healthcare-associated infective endocarditis (NNHCA-IE) is a new category of IE of increasing importance. This study described the clinical and microbiological characteristics and outcome of NNHCA-IE in Taiwan.

Methods

A retrospective study was conducted of all patients with IE admitted to the Kaohsiung Veterans General Hospital in Kaohsiung, Taiwan over a five-year period from July 2004 to July 2009. The clinical and microbiological features of NNHCA-IE were compared to those of community-acquired and nosocomial IE. Predictors for in-hospital death were determined.

Results

Two-hundred episodes of confirmed IE occurred during the study period. These included 148 (74%) community-acquired, 30 (15%) non-nosocomial healthcare-associated, and 22 (11%) nosocomial healthcare-associated IE. Staphylococcus aureus was the most frequent pathogen. Patients with NNHCA-IE compared to community-acquired IE, were older (median age, 67 vs. 44, years, p < 0.001), had more MRSA (43.3% vs. 9.5%, p < 0.001), more comorbidity conditions (median Charlson comorbidity index [interquartile range], 4[2-6] vs. 0[0-1], p < 0.001), a higher in-hospital mortality (50.0% vs. 17.6%, p < 0.001) and were less frequently recognized by clinicians on admission (16.7% vs. 47.7%, p = 0.002). The overall in-hospital mortality rate for all patients with IE was 25%. Shock was the strongest risk factor for in-hospital death (odds ratio 7.8, 95% confidence interval 2.4-25.2, p < 0.001).

Conclusions

NNHCA-IE is underrecognized and carries a high mortality rate. Early recognition is crucial to provide optimal management and improve outcome.