Abstract • Nosocomial endocarditis occurred in 22 patients who were discharged from a university hospital, a veterans' hospital, and a community hospital during the period of January 1976 to December 1985. Nosocomial episodes were 14.3% of the total endocarditis cases seen. Fourteen (63.6%) of 22 nosocomial endocarditis episodes occurred in patients over the age of 60 years, compared with 39 (29.5%) of 132 episodes of community-acquired endocarditis during the same period. Nosocomial endocarditis was due predominantly to Staphylococcus aureus or coagulase-negative staphylococci (77.4%) and, less often, to streptococci (13.6%). Intravascular devices were the source of bacteremia in ten (45.5%) of the nosocomial endocarditis episodes. The overall mortality rate was 40.9%, 50% in patients over the age of 60 years. Improved care of intravascular devices or prophylaxis before procedures could probably have prevented endocarditis in 12 of the 22 patients. (Arch Intern Med 1988;148:1601-1603) References 1. Horan TC, White JW, Jarvis WR, et al: Nosocomial infection surveillance, 1984. MMWR 1986;35:17SS-29SS. 2. Maki DG: Nosocomial bacteremia: An epidemiologic overview. Am J Med 1981;70:719-732.Crossref 3. Rowley KM, Clubb KS, Smith GJW, et al: Right-sided infective endocarditis as a consequence of flow-directed pulmonary-artery catheterization. N Engl J Med 1984;311:1152-1156.Crossref 4. Oelberg DG, Fisher DJ, Gross DM, et al: Endocarditis in high-risk neonates. Pediatrics 1983;71:392-397. 5. Calderwood SB, Swinski LA, Waternaux CM, et al: Risk factors for the development of prosthetic valve endocarditis. Circulation 1985;72:31-37.Crossref 6. Guze LB, Pearce ML. Hospital-acquired bacterial endocarditis. Arch Intern Med 1963;112:56-62.Crossref 7. Friedland G, von Reyn CF, Levy B, et al: Nosocomial endocarditis. Infect Control 1984;5:284-288. 8. Terpenning MS, Buggy BP, Kauffman CA: Infective endocarditis: Clinical features in young and elderly patients. Am J Med 1987;83:626-634.Crossref 9. Von Reyn CF, Levy B, Arbeit R, et al: Infective endocarditis: An analysis based on strict case definitions. Ann Intern Med 1981;94:505-518.Crossref 10. Venezio FR, Westenfelder GO, Cook FV, et al: Infective endocarditis in a community hospital. Arch Intern Med 1982;142:789-792.Crossref 11. Pelletier LL, Petersdorf RG: Infective endocarditis: A review of 125 cases from the University of Washington Hospitals, 1963-1972. Medicine 1977;56:287-323.Crossref 12. Garvey GJ, Neu HC: Infective endocarditis: An evolving disease. Medicine 1978;57:105-127.Crossref 13. Gross PA, Van Antwerpen C: Nosocomial infections and hospital deaths: A case-control study. Am J Med 1983;75:658-662.Crossref 14. Watanakunakorn C, Tan JS, Phair JP: Some salient features of Staphylococcus aureus endocarditis. Am J Med 1973;54:473-481.Crossref 15. Powell DC, Bivins BA, Bell RM, et al: Bacterial endocarditis in the critically ill surgical patient. Arch Surg 1981;116:311-314.Crossref 16. Watanakunakorn C, Baird IM: Staphylococcus aureus bacteremia and endocarditis associated with a removable infected intravenous device. Am J Med 1977;63:253-256.Crossref 17. Maki DG, Goldman DA, Rhame FS: Infection control in intravenous therapy. Ann Intern Med 1973;79:867-887.Crossref 18. Iannini PB, Crossley K: Therapy of Staphylococcus aureus bacteremia associated with a removable focus of infection. Ann Intern Med 1976;84:558-560.Crossref 19. Bayer AS: Staphylococcal bacteremia and endocarditis: State of the art. Arch Intern Med 1982;142:1169-1177.Crossref 20. Shulman ST, Amren DP, Bisno AL, et al: Prevention of bacterial endocarditis. Circulation 1984;70:1123A-1127A.
Archives of Internal Medicine – American Medical Association
Published: Jul 1, 1988