NOSOCOMIAL INFECTIVE ENDOCARDITIS IN PATI ENTS WITHOUT CARDIAC PROSTHESIS

Background. infective endocarditis is a complication of nosocomial bac teremia and is associated with a high mortality rate. The objective of the present study was to know the clinical and microbiological charac teristics of nosocomial endocarditis (NE) diagnosed in a general hospi tal in a five-year period. Patients and methods. Twenty-one patients d iagnosed of NE following Durack's criteria at Juan Canalejo Hospital f rom January 1990 to January 1995 were studied. Endocarditis in patient s with cardiac valve prosthesis were excluded. Results. NE represented 12% of the total endocarditis cases diagnosed during the study period . The mean age of patients was 52.6 years (range: 17-79 years) and mal e accounted for 81% of cases. NE was related to an intravascular cathe ter in 85.7% of cases, whereas a urinary source was found in 14.3%. St aphylococcus aureus was the microorganism recovered most frequently (6 2%), followed by Staphylococcus epidermidis (20%), which was always as sociated with intravascular catheters. Left valve involvement predomin ated (76.2%) and the involvement of right cavities was detected exclus ively in patients with an intravascular catheter as known source of NE . Transoesophageal echocardiography detected vegetations in 19% of cas es in which transthoracic echography failed to identify them. Surgery was required by 28.5% of patients and its indication was always conges tive heart failure refractory to medical treatment. The overall mortal ity rate was 28.5%, compared with 26.8% in community acquired endocard itis. Two patients with Candida spp. endocarditis were not treated sur gically and the outcome was satisfactory. Conclusions. Nosocomial endo carditis represent a significant percentage of endocarditis once endoc arditis on prosthetic cardiac valves has been excluded. To remark Stap hylococcus sop. in the etiology of this entity, the intravascular cath eter as risk factor and left cavities as location. Transoesophageal ec hocardiography is of great diagnostic usefulness. In contrast with rep orts in literature, the mortality rate in our series was similar to th at of community endocarditis.