University of Tennessee Health Science Center, Knoxville, Tennessee, United States of America.
University of Tennessee Medical Center, Knoxville, Tennessee, United States of America.
PLoS One. 2020 Mar 10;15(3):e0230199. doi: 10.1371/journal.pone.0230199. eCollection 2020.
Infective endocarditis (IE) with non-HACEK Gram-negative (GN) organisms is rare, but associated with poor outcomes. The purpose of this study was to quantify the microbiology, treatment strategies, and frequency of poor outcomes in patients with non-HACEK GN IE.
Retrospective cohort of adults with definite non-HACEK GN IE from 1/11-1/19. The primary endpoint was poor patient outcome, defined as a composite of all-cause death or infection-related readmission within 90-days of index infection.
43 patients were included: 51% patients were men, and the median (IQR) age was 40 (31-50) years. Forty patients reported injection drug use. The most common organisms were Pseudomonas aeruginosa (68%) and Serratia marcescens (9%). Seventy-six percent of patients received definitive combination therapy; the most common antibiotics used in combination with a β-lactam were aminoglycosides (50%) and fluoroquinolones (34%). Three patients discontinued combination therapy due to toxicity. Twelve-month, all-cause mortality and readmission was 30% and 54%, respectively. In multivariable logistic regression, variables independently associated with composite poor outcome were receipt of fluoroquinolone-based IE combination therapy and septic shock.
Long-term mortality and readmission rates were high. Patients who received fluoroquinolone-based IE combination therapy more frequently developed poor outcomes than those who did not.
非 HACEK 革兰氏阴性（GN）菌引起的感染性心内膜炎（IE）很少见，但与不良预后相关。本研究旨在量化非 HACEK GN IE 患者的微生物学、治疗策略和不良预后的频率。
1/11-1/19 期间成人明确的非 HACEK GN IE 的回顾性队列。主要终点是患者不良结局，定义为指数感染后 90 天内全因死亡或感染相关再入院的复合终点。
共纳入 43 例患者：51%的患者为男性，中位数（IQR）年龄为 40（31-50）岁。40 例患者报告有注射吸毒史。最常见的病原体是铜绿假单胞菌（68%）和粘质沙雷氏菌（9%）。76%的患者接受了明确的联合治疗；与β-内酰胺联合使用最常见的抗生素是氨基糖苷类（50%）和氟喹诺酮类（34%）。由于毒性，有 3 例患者停止了联合治疗。12 个月时的全因死亡率和再入院率分别为 30%和 54%。多变量逻辑回归分析显示，与复合不良预后独立相关的变量是氟喹诺酮类 IE 联合治疗和感染性休克的接受情况。
长期死亡率和再入院率较高。接受氟喹诺酮类 IE 联合治疗的患者比未接受的患者更常出现不良结局。
