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

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.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).NNHCA-IE is underrecognized and carries a high mortality rate. Early recognition is crucial to provide optimal management and improve outcome.Infective endocarditis (IE) is a serious disease with a high mortality rate, of up to 16-25% [1-6]. Major changes have occurred in the epidemiology of IE in association with advances in medical and surgical care. Rheumatic heart disease has been replaced as the major risk factor for IE by degenerative valve diseases, hemodialysis, prosthetic valve replacement, and intravenous drug use (IVDU) [2,7-10]. Staphylococci, instead of Streptococci, have become the most common pathogen in IE patients in recent series [7,8,11].Nosocomial IE is associated with the highest mortality rate among all forms of IE [10,12]. Nosoco