Contemporary Epidemiology and Prognosis of Health Care–Associated Infective Endocarditis

Background. The aim of this study was to describe the characteristics of health care–associated infective endocarditis (HAIE) and to establish the risk factors for mortality. Methods. We conducted a prospective, observational cohort study. HAIE was defined according to the following conditions: (1) symptom onset 148 h after hospitalization or within 6 months after hospital discharge; or (2) ambulatory manipulations causing endocarditis. Results. Eighty-three episodes of HAIE (accounting for 28.4 % of all cases of endocarditis) were diagnosed. Compared with patients with community-acquired endocarditis, patients with HAIE were older (median age standard deviation, years vs. years;), were in poorer health before disease onset65.3 16.4 57.8 17.0 Pp.001 (Charlson index, vs.;), had more staphylococcal (55.4 % vs. 28.3 % of cases) and2.5 2.3 1.7 2.1 Pp.006 enterococcal infections (22.9 % vs. 7.7 % of cases;), underwent fewer surgeries (22.9 % vs. 45.9 % of cases;P!.005), and experienced a higher rate of in-hospital (45.8 % vs. 22.0%) and 1-year mortality (59.5 % vs. 29.6%;P!.005). In the HAIE cohort, independent predictors of in-hospital death were stroke (odds ratio [OR], 8.95;P!.005 95 % confidence interval [CI], 2.04–39.31;), congestive heart failure (OR, 5.48; 95 % CI, 1.77–17.03;Pp.004), surgery indicated but not performed (OR, 3.74; 95 % CI, 1.22–11.45;), and enterococcalPp.003 Pp.021 infection (OR, 0.18; 95 % CI, 0.04–0.78;). Independent predictors of 1-year mortality were surgeryPp.02