HOSPITAL-ACQUIRED INFECTIOUS ENDOCARDITIS NOT ASSOCIATED WITH CARDIAC-SURGERY - AN EMERGING PROBLEM

To assess the most relevant features of hospital-acquired endocarditis , we conducted a retrospective study of cases of infectious endocardit is at a single university hospital from 1978 through 1992. During this period 248 episodes of infectious endocarditis were documented; 23 (9 .3%) of these episodes were hospital-acquired and were not associated with cardiac surgery. (This figure represented a remarkable rise in th e frequency of nosocomial endocarditis, only one case of which was ide ntified among 101 cases of endocarditis treated at the same institutio n between 1960 and 1975.) In each of the 23 nosocomial cases, endocard itis was the result of bacteremia associated with a hospital-based pro cedure: intravenous catheterization (15 cases), instrumentation of a d iseased urogenital tract (seven cases), or liver biopsy (one case). St aphylococcus aureus and Enterococcus faecalis were the predominant org anisms isolated from intravenous catheters and the urogenital tract, r espectively. Two of seven enterococcal isolates were highly resistant to gentamicin (MIC, >2,000 mu g/mL). Overall mortality was 56%. Two su bsets of at-risk patients with different anatomic and clinical manifes tations were identified. Out results emphasize that infectious endocar ditis must be considered a serious nosocomial hazard against which pre ventive measures must be implemented.