de Sousa Leonardo Paiva, Fortes Cláudio Querido, Damasco Paulo Vieira, Barbosa Giovanna Ianini Ferraiuoli, Golebiovski Wilma Felix, Weksler Clara, Garrido Rafael Quaresma, Siciliano Rinaldo Focaccia, Lamas Cristiane da Cruz
Instituto Nacional de Cardiologia, Rio de Janeiro 22240-006, Brazil.
Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-900, Brazil.
Trop Med Infect Dis. 2023 May 17;8(5):283. doi: 10.3390/tropicalmed8050283.
Non-HACEK Gram-negative bacilli (NGNB) infective endocarditis (IE) has a growing frequency. We aimed to describe cases of NGNB IE and find associated risk factors. We conducted a prospective observational study of consecutive patients with definitive IE according to the modified Duke criteria in four institutions in Brazil. Of 1154 adult patients enrolled, 38 (3.29%) had IE due to NGNB. Median age was 57 years, males predominated, accounting for 25/38 (65.8%). Most common etiologies were and spp. (8 episodes, 21% each). Worsening heart failure occurred in 18/38 (47.4%). Higher prevalence of embolic events was found (55,3%), mostly to the central nervous system 7/38 (18.4%). Vegetations were most commonly on aortic valves 17/38 (44.7%). Recent healthcare exposure was found in 52.6% and a central venous catheter (CVC) in 13/38 (34.2%). Overall mortality was 19/38 (50%). Indwelling CVC (OR 5.93; 95% CI, 1.29 to 27.3; = 0.017), hemodialysis (OR 16.2; 95% CI, 1.78 to 147; = 0.008) and chronic kidney disease (OR 4.8; 95% IC, 1.2 to 19.1, = 0.049) were identified as risk factors for mortality. The rate of IE due to NGNB was similar to that in previous studies. and were the most common etiologies. NGNB IE was associated with central venous catheters, prosthetic valves, intracardiac devices and hemodialysis and had a high mortality rate.
非嗜二氧化碳噬纤维菌属革兰氏阴性杆菌（NGNB）感染性心内膜炎（IE）的发病率呈上升趋势。我们旨在描述NGNB IE病例并找出相关危险因素。我们在巴西的四个机构对符合改良杜克标准的连续性确诊IE患者进行了一项前瞻性观察研究。在纳入的1154例成年患者中，38例（3.29%）患有NGNB所致的IE。中位年龄为57岁，男性居多，占25/38（65.8%）。最常见的病原体是[此处原文缺失具体菌名]和[此处原文缺失具体菌名]菌属（各8例，占21%）。18/38（47.4%）患者出现心力衰竭加重。栓塞事件的发生率较高（55.3%），主要累及中枢神经系统，7/38（18.4%）。赘生物最常见于主动脉瓣，17/38（44.7%）。52.6%的患者近期有医疗接触史，13/38（34.2%）有中心静脉导管（CVC）。总死亡率为19/38（50%）。留置CVC（比值比5.93；95%置信区间，1.29至27.3；P = 0.017）、血液透析（比值比16.2；95%置信区间，1.78至147；P = 0.008）和慢性肾脏病（比值比4.8；95%置信区间，1.2至19.1，P = 0.049）被确定为死亡的危险因素。NGNB所致IE的发生率与以往研究相似。[此处原文缺失具体菌名]和[此处原文缺失具体菌名]是最常见的病原体。NGNB IE与中心静脉导管、人工瓣膜、心内装置和血液透析相关，且死亡率较高。
