Epidemiology and outcomes of non-HACEK infective endocarditis in the southeast United States
Infective endocarditis (IE) with non-HACEK Gram-negative (GN) organisms is rare, but associated with poor outcomes. The purpose of this study was to quantify the microbiology, treatment strategies, and frequency of poor outcomes in patients with non-HACEK GN IE. Retrospective cohort of adults with d...
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| creator | Veve, Michael P McCurry, Eric D Cooksey, Grace E Shorman, Mahmoud A |
| description | Infective endocarditis (IE) with non-HACEK Gram-negative (GN) organisms is rare, but associated with poor outcomes. The purpose of this study was to quantify the microbiology, treatment strategies, and frequency of poor outcomes in patients with non-HACEK GN IE.
Retrospective cohort of adults with definite non-HACEK GN IE from 1/11-1/19. The primary endpoint was poor patient outcome, defined as a composite of all-cause death or infection-related readmission within 90-days of index infection.
43 patients were included: 51% patients were men, and the median (IQR) age was 40 (31-50) years. Forty patients reported injection drug use. The most common organisms were Pseudomonas aeruginosa (68%) and Serratia marcescens (9%). Seventy-six percent of patients received definitive combination therapy; the most common antibiotics used in combination with a β-lactam were aminoglycosides (50%) and fluoroquinolones (34%). Three patients discontinued combination therapy due to toxicity. Twelve-month, all-cause mortality and readmission was 30% and 54%, respectively. In multivariable logistic regression, variables independently associated with composite poor outcome were receipt of fluoroquinolone-based IE combination therapy and septic shock.
Long-term mortality and readmission rates were high. Patients who received fluoroquinolone-based IE combination therapy more frequently developed poor outcomes than those who did not. |
| doi_str_mv | 10.1371/journal.pone.0230199 |
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Retrospective cohort of adults with definite non-HACEK GN IE from 1/11-1/19. The primary endpoint was poor patient outcome, defined as a composite of all-cause death or infection-related readmission within 90-days of index infection.
43 patients were included: 51% patients were men, and the median (IQR) age was 40 (31-50) years. Forty patients reported injection drug use. The most common organisms were Pseudomonas aeruginosa (68%) and Serratia marcescens (9%). Seventy-six percent of patients received definitive combination therapy; the most common antibiotics used in combination with a β-lactam were aminoglycosides (50%) and fluoroquinolones (34%). Three patients discontinued combination therapy due to toxicity. Twelve-month, all-cause mortality and readmission was 30% and 54%, respectively. In multivariable logistic regression, variables independently associated with composite poor outcome were receipt of fluoroquinolone-based IE combination therapy and septic shock.
Long-term mortality and readmission rates were high. Patients who received fluoroquinolone-based IE combination therapy more frequently developed poor outcomes than those who did not.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0230199</identifier><identifier>PMID: 32155223</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Amides ; Aminoglycosides ; Antibacterial agents ; Antibiotics ; Beta lactamases ; Biology and Life Sciences ; Care and treatment ; Clinical outcomes ; Death ; Drug abuse ; Drug use ; Endocarditis ; Epidemiology ; Fluoroquinolones ; Gram-positive bacteria ; Heart surgery ; Hospitals ; Infection ; Infections ; Infectious diseases ; Infective endocarditis ; Lactams ; Medical records ; Medicine and Health Sciences ; Microbiology ; Mortality ; Narcotics ; Organisms ; Patient outcomes ; Patients ; Prostheses ; Pseudomonas aeruginosa ; Sepsis ; Septic shock ; Shock ; Therapy ; Toxicity ; Variables ; β-Lactam antibiotics</subject><ispartof>PloS one, 2020-03, Vol.15 (3), p.e0230199-e0230199</ispartof><rights>COPYRIGHT 2020 Public Library of Science</rights><rights>2020 Veve et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2020 Veve et al 2020 Veve et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-3b5aff0ad9074e448a6a2f65bedb8f55533f1d06e4a8e150ca7c72e05d40699d3</citedby><cites>FETCH-LOGICAL-c692t-3b5aff0ad9074e448a6a2f65bedb8f55533f1d06e4a8e150ca7c72e05d40699d3</cites><orcidid>0000-0001-5967-5211 ; 0000-0003-3371-5101</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7064227/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7064227/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79472,79473</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32155223$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Crivellari, Martina</contributor><creatorcontrib>Veve, Michael P</creatorcontrib><creatorcontrib>McCurry, Eric D</creatorcontrib><creatorcontrib>Cooksey, Grace E</creatorcontrib><creatorcontrib>Shorman, Mahmoud A</creatorcontrib><title>Epidemiology and outcomes of non-HACEK infective endocarditis in the southeast United States</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Infective endocarditis (IE) with non-HACEK Gram-negative (GN) organisms is rare, but associated with poor outcomes. The purpose of this study was to quantify the microbiology, treatment strategies, and frequency of poor outcomes in patients with non-HACEK GN IE.
Retrospective cohort of adults with definite non-HACEK GN IE from 1/11-1/19. The primary endpoint was poor patient outcome, defined as a composite of all-cause death or infection-related readmission within 90-days of index infection.
43 patients were included: 51% patients were men, and the median (IQR) age was 40 (31-50) years. Forty patients reported injection drug use. The most common organisms were Pseudomonas aeruginosa (68%) and Serratia marcescens (9%). Seventy-six percent of patients received definitive combination therapy; the most common antibiotics used in combination with a β-lactam were aminoglycosides (50%) and fluoroquinolones (34%). Three patients discontinued combination therapy due to toxicity. Twelve-month, all-cause mortality and readmission was 30% and 54%, respectively. In multivariable logistic regression, variables independently associated with composite poor outcome were receipt of fluoroquinolone-based IE combination therapy and septic shock.
Long-term mortality and readmission rates were high. Patients who received fluoroquinolone-based IE combination therapy more frequently developed poor outcomes than those who did not.</description><subject>Amides</subject><subject>Aminoglycosides</subject><subject>Antibacterial agents</subject><subject>Antibiotics</subject><subject>Beta lactamases</subject><subject>Biology and Life Sciences</subject><subject>Care and treatment</subject><subject>Clinical outcomes</subject><subject>Death</subject><subject>Drug abuse</subject><subject>Drug use</subject><subject>Endocarditis</subject><subject>Epidemiology</subject><subject>Fluoroquinolones</subject><subject>Gram-positive bacteria</subject><subject>Heart surgery</subject><subject>Hospitals</subject><subject>Infection</subject><subject>Infections</subject><subject>Infectious diseases</subject><subject>Infective endocarditis</subject><subject>Lactams</subject><subject>Medical records</subject><subject>Medicine and Health 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One</addtitle><date>2020-03-10</date><risdate>2020</risdate><volume>15</volume><issue>3</issue><spage>e0230199</spage><epage>e0230199</epage><pages>e0230199-e0230199</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Infective endocarditis (IE) with non-HACEK Gram-negative (GN) organisms is rare, but associated with poor outcomes. The purpose of this study was to quantify the microbiology, treatment strategies, and frequency of poor outcomes in patients with non-HACEK GN IE.
Retrospective cohort of adults with definite non-HACEK GN IE from 1/11-1/19. The primary endpoint was poor patient outcome, defined as a composite of all-cause death or infection-related readmission within 90-days of index infection.
43 patients were included: 51% patients were men, and the median (IQR) age was 40 (31-50) years. Forty patients reported injection drug use. The most common organisms were Pseudomonas aeruginosa (68%) and Serratia marcescens (9%). Seventy-six percent of patients received definitive combination therapy; the most common antibiotics used in combination with a β-lactam were aminoglycosides (50%) and fluoroquinolones (34%). Three patients discontinued combination therapy due to toxicity. Twelve-month, all-cause mortality and readmission was 30% and 54%, respectively. In multivariable logistic regression, variables independently associated with composite poor outcome were receipt of fluoroquinolone-based IE combination therapy and septic shock.
Long-term mortality and readmission rates were high. Patients who received fluoroquinolone-based IE combination therapy more frequently developed poor outcomes than those who did not.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>32155223</pmid><doi>10.1371/journal.pone.0230199</doi><tpages>e0230199</tpages><orcidid>https://orcid.org/0000-0001-5967-5211</orcidid><orcidid>https://orcid.org/0000-0003-3371-5101</orcidid><oa>free_for_read</oa></addata></record> |
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| source | DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Amides Aminoglycosides Antibacterial agents Antibiotics Beta lactamases Biology and Life Sciences Care and treatment Clinical outcomes Death Drug abuse Drug use Endocarditis Epidemiology Fluoroquinolones Gram-positive bacteria Heart surgery Hospitals Infection Infections Infectious diseases Infective endocarditis Lactams Medical records Medicine and Health Sciences Microbiology Mortality Narcotics Organisms Patient outcomes Patients Prostheses Pseudomonas aeruginosa Sepsis Septic shock Shock Therapy Toxicity Variables β-Lactam antibiotics |
| title | Epidemiology and outcomes of non-HACEK infective endocarditis in the southeast United States |
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