Maladies infectieuses et Réanimation médicale, Hôpital Pontchailllou, Centre Hospitalier Universitaire, Rennes, Rennes, France.
Maladies Infectieuses, CIC 1413 INSERM, Hôtel Dieu, Centre Hospitalier Universitaire, Nantes, Nantes, France.
Infect Dis (Lond). 2023 Sep;55(9):599-606. doi: 10.1080/23744235.2023.2226212. Epub 2023 Jun 24.
Infective endocarditis (IE) caused by non-HACEK gram-negative bacilli (GNB) is poorly characterised and may be emerging as a consequence of medical progress.
We performed an observational retrospective case-control study. Cases were non-HACEK GNB IE, definite or possible (modified Duke criteria), diagnosed in adults between 2007 and 2020 in six French referral hospitals. Two controls were included for each case (IE due to other bacteria, matched by sites and diagnosis date).
Non-HACEK GNB were identified in 2.4% (77/3230) of all IE during the study period, with a mean age of 69.2 ± 14.6 years, and a large male predominance (53/77, 69%). Primary pathogens were ( = 33), sp. ( = 12) and ( = 9), including eight (10%) multidrug-resistant GNB. Compared to controls ( = 154: 43% sp., 41% sp. and 12% sp.), non-HACEK GNB IE were independently associated with intravenous drug use (IVDU, 8% vs. 2%, = .003), active neoplasia (15% vs. 6%, = .009), haemodialysis (9% vs. 3%, = .007) and healthcare-associated IE (36% vs. 18%, = .002). Urinary tract was the main source of infection ( = 25, 33%) and recent invasive procedures were reported in 29% of cases. Non-HACEK GNB IE were at lower risk of embolism (31% vs. 47%, = .002). One-year mortality was high ( = 28, 36%). Comorbidities, particularly malignant hemopathy and cirrhosis, were associated with increased risk of death.
Non-HACEK GNB are rarely responsible for IE, mostly as healthcare-associated IE in patients with complex comorbidities (end-stage renal disease, neoplasia), or in IVDUs.
由非 HACEK 革兰氏阴性杆菌（GNB）引起的感染性心内膜炎（IE）特征不明显，可能是医学进步的结果。
我们进行了一项观察性回顾性病例对照研究。病例为 2007 年至 2020 年期间在法国六家转诊医院确诊的成人非 HACEK GNB IE，明确或可能（改良 Duke 标准）。每个病例纳入 2 个对照（IE 由其他细菌引起，按部位和诊断日期匹配）。
在研究期间，所有 IE 中 2.4%（77/3230）确定为非 HACEK GNB，平均年龄为 69.2±14.6 岁，男性居多（53/77，69%）。主要病原体为 （=33）、 sp.（=12）和 （=9），包括 8 株（10%）多重耐药 GNB。与对照组（=154：43% sp.，41% sp.，12% sp.）相比，非 HACEK GNB IE 与静脉药物使用（IVDU，8%比 2%，=0.003）、活动性肿瘤（15%比 6%，=0.009）、血液透析（9%比 3%，=0.007）和与医疗保健相关的 IE（36%比 18%，=0.002）独立相关。尿路感染是感染的主要来源（=25，33%），29%的病例报告有近期侵入性操作。非 HACEK GNB IE 栓塞风险较低（31%比 47%，=0.002）。一年死亡率较高（=28，36%）。合并症，特别是恶性血液病和肝硬化，与死亡风险增加相关。
非 HACEK GNB 很少引起 IE，主要是与复杂合并症（终末期肾病、肿瘤）相关的与医疗保健相关的 IE，或与 IVDU 相关的 IE。
