HOSPITAL PRACTICES INFLUENCE THE PATTERN OF INFECTIVE ENDOCARDITIS

Objective: To identify factors contributing to infective endocarditis at a major teaching hospital. Methods: Retrospective review of clinica l records of patients diagnosed with endocarditis by standard case def initions with respect to causative organisms, clinical features and ou tcome. Results: One hundred and ninety-three episodes of endocarditis seen between 1979 and 1992 at Westmead Hospital, Sydney, were reviewed . In the 174 cases where the causative organism was isolated, 75 (43%) were Staphylococcus aureus and 50 (29%) were viridans streptococci. N osocomial acquisition and/or interhospital transfer accounted for 83 e pisodes; 48 (58%) S. aureus (P<0.001) and nine (11%) viridans streptoc occi (P<0.001). In cases from the local community, viridans streptococ ci were more common than S. aureus (37% versus 25%); these included 18 episodes (14 S. aureus) in intravenous drug users. Conclusion: We con clude that, compared with community-acquired infections, the aetiology of endocarditis in a large teaching hospital is influenced strongly b y the prevalence of nosocomial endocarditis and the need for interhosp ital transfer of complicated cases.