Abstract
The HACEK organisms (Haemophilus species, Aggregatibacter species, Cardiobacterium hominis, Eikenella corrodens, and Kingella species) are rare causes of infective endocarditis (IE). The objective of this study is to describe the clinical characteristics and outcomes of patients with HACEK endocarditis (HE) in a large multi-national cohort. Patients hospitalized with definite or possible infective endocarditis by the International Collaboration on Endocarditis Prospective Cohort Study in 64 hospitals from 28 countries were included and characteristics of HE patients compared with IE due to other pathogens. Of 5591 patients enrolled, 77 (1.4%) had HE. HE was associated with a younger age (47 vs. 61 years; p<0.001), a higher prevalence of immunologic/vascular manifestations (32% vs. 20%; p<0.008) and stroke (25% vs. 17% p = 0.05) but a lower prevalence of congestive heart failure (15% vs. 30%; p = 0.004), death in-hospital (4% vs. 18%; p = 0.001) or after 1 year follow-up (6% vs. 20%; p = 0.01) than IE due to other pathogens (n = 5514). On multivariable analysis, stroke was associated with mitral valve vegetations (OR 3.60; CI 1.34-9.65; p<0.01) and younger age (OR 0.62; CI 0.49-0.90; p<0.01). The overall outcome of HE was excellent with the in-hospital mortality (4%) significantly better than for non-HE (18%; p<0.001). Prosthetic valve endocarditis was more common in HE (35%) than non-HE (24%). The outcome of prosthetic valve and native valve HE was excellent whether treated medically or with surgery. Current treatment is very successful for the management of both native valve prosthetic valve HE but further studies are needed to determine why HE has a predilection for younger people and to cause stroke. The small number of patients and observational design limit inferences on treatment strategies. Self selection of study sites limits epidemiological inferences.
| Original language | English |
|---|---|
| Article number | e63181 |
| Journal | PLoS ONE |
| Volume | 8 |
| Issue number | 5 |
| DOIs | |
| State | Published - 17 May 2013 |
| Externally published | Yes |
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In: PLoS ONE, Vol. 8, No. 5, e63181, 17.05.2013.
Research output: Contribution to journal › Article › peer-review
TY - JOUR
T1 - HACEK Infective Endocarditis
T2 - Characteristics and Outcomes from a Large, Multi-National Cohort
AU - Chambers, Stephen T.
AU - Murdoch, David R.
AU - Morris, Arthur
AU - Holland, David
AU - Pappas, Paul
AU - Almela, Manel
AU - Ferna´ndez-Hidalgo, Nuria
AU - Almirante, Benito
AU - Bouza, Emilio
AU - Forno, Davide
AU - del Rio, Ana
AU - Hannan, Margaret M.
AU - Harkness, John
AU - Kanafani, Zeina A.
AU - Lalani, Tahaniyat
AU - Lang, Selwyn
AU - Raymond, Nigel
AU - Read, Kerry
AU - Vinogradova, Tatiana
AU - Woods, Christopher W.
AU - Wray, Dannah
AU - Corey, G. Ralph
AU - Chu, Vivian H.
AU - Clara, Liliana
AU - Sanchez, Marisa
AU - Nacinovich, Francisco
AU - Oses, Pablo Fernandez
AU - Ronderos, Ricardo
AU - Sucari, Adriana
AU - Thierer, Jorge
AU - Casabe´, Jose´
AU - Cortes, Claudia
AU - Altclas, Javier
AU - Silvia Kogan, Sanatorio
AU - Spelman, Denis
AU - Athan, Eugene
AU - Harris, Owen
AU - Kennedy, Karina
AU - Tan, Ren
AU - Gordon, David
AU - Papanicolas, Lito
AU - Eisen, Damon
AU - Grigg, Leeanne
AU - Street, Alan
AU - Korman, Tony
AU - Kotsanas, Despina
AU - Dever, Robyn
AU - Jones, Phillip
AU - Konecny, Pam
AU - Lawrence, Richard
AU - Rees, David
AU - Ryan, Suzanne
AU - Feneley, Michael P.
AU - Post, Jeffrey
AU - Reinbott, Porl
AU - Gattringer, Rainer
AU - Wiesbauer, Franz
AU - Andrade, Adriana Ribas
AU - de Brito, Ana Cla´udia Passos
AU - Guimara~es, Armenio Costa
AU - Grinberg, Max
AU - Mansur, Alfredo Jose´
AU - Siciliano, Rinaldo Focaccia
AU - Strabelli, Tania Mara Varejao
AU - Vieira, Marcelo Luiz Campos
AU - de Medeiros Tranchesi, Regina Aparecida
AU - Paiva, Marcelo Goulart
AU - Fortes, Claudio Querido
AU - de Oliveira Ramos, Auristela
AU - Ferraiuoli, Giovanna
AU - Golebiovski, Wilma
AU - Lamas, Cristiane
AU - Santos, Marisa
AU - Weksler, Clara
AU - Karlowsky, James A.
AU - Keynan, Yoav
AU - Morris, Andrew M.
AU - Rubinstein, Ethan
AU - Jones, Sandra Braun
AU - Garcia, Patricia
AU - Cereceda, M.
AU - Fica, Alberto
AU - Mella, Rodrigo Montagna
AU - Barsic, Bruno
AU - Bukovski, Suzana
AU - Krajinovic, Vladimir
AU - Pangercic, Ana
AU - Rudez, Igor
AU - Vincelj, Josip
AU - Freiberger, Tomas
AU - Pol, Jiri
AU - Zaloudikova, Barbora
AU - Ashour, Zainab
AU - Kholy, Amani El
AU - Mishaal, Marwa
AU - Rizk, Hussien
AU - Aissa, Neijla
AU - Alauzet, Corentine
AU - Alla, Francois
AU - Campagnac, Catherine
AU - Doco-Lecompte, Thanh
AU - Selton-Suty, Christine
AU - Casalta, Jean Paul
AU - Fournier, Pierre Edouard
AU - Habib, Gilbert
AU - Raoult, Didier
AU - Thuny, Franck
AU - Delahaye, Francois
AU - Delahaye, Armelle
AU - Vandenesch, Francois
AU - Donal, Erwan
AU - Donnio, Pierre Yves
AU - Michelet, Christian
AU - Revest, Matthieu
AU - Tattevin, Pierre
AU - Violette, Je´re´mie
AU - Chevalier, Florent
AU - Jeu, Antoine
AU - Rusinaru, Dan M.D.
AU - Sorel, Claire
AU - Tribouilloy, Christophe
AU - Bernard, Yvette
AU - Chirouze, Catherine
AU - Hoen, Bruno
AU - Leroy, Joel
AU - Plesiat, Patrick
AU - Naber, Christoph
AU - Neuerburg, Carl
AU - Mazaheri, Bahram
AU - Athanasia, Sofia
AU - Giannitsioti, Efthymia
AU - Mylona, Elena
AU - Paniara, Olga
AU - Papanicolaou, Konstantinos
AU - Pyros, John
AU - Skoutelis, Athanasios
AU - Sharma, Gautam
AU - Francis, Johnson
AU - Nair, Lathi
AU - Thomas, Vinod
AU - Venugopal, Krishnan
AU - Hurley, John
AU - Gilon, Dan
AU - Israel, Sarah
AU - Korem, Maya
AU - Strahilevitz, Jacob
AU - Tripodi, Marie Franc¸oise
AU - Casillo, Roberta
AU - Cuccurullo, Susanna
AU - Dialetto, Giovanni
AU - Durante-Mangoni, Emanuele
AU - Irene, Mattucci
AU - Ragone, Enrico
AU - Utili, Riccardo
AU - Cecchi, Enrico
AU - De Rosa, Francesco
AU - Imazio, Massimo
AU - Trinchero, Rita
AU - Tebini, Alessandro
AU - Grossi, Paolo
AU - Lattanzio, Mariangela
AU - Toniolo, Antonio
AU - Goglio, Antonio
AU - Raglio, Annibale
AU - Ravasio, Veronica
AU - Rizzi, Marco
AU - Suter, Fredy
AU - Carosi, Giampiero
AU - Magri, Silvia
AU - Signorini, Liana
AU - Baban, Tania
AU - Kanj, Souha S.
AU - Sfeir, Jad
AU - Yasmine, Mohamad
AU - Abidin, Imran
AU - Tamin, Syahidah Syed
AU - Marti´nez, Eduardo Rivera
AU - Nieto, Gabriel Israel Soto
AU - van der Meer, Jan T.M.
AU - Morris, Arthur
AU - Dragulescu, Stefan
AU - Ionac, Adina
AU - Mornos, Cristian
AU - Butkevich, O. M.
AU - Chipigina, Natalia
AU - Kirill, Ozerecky
AU - Vadim, Kulichenko
AU - Edathodu, Jameela
AU - Halim, Magid
AU - Lum, Luh Nah
AU - Tan, Ru San
AU - Lejko-Zupanc, Tatjana
AU - Logar, Mateja
AU - Mueller-Premru, Manica
AU - Commerford, Patrick
AU - Commerford, Anita
AU - Deetlefs, Eduan
AU - Hansa, Cass
AU - Ntsekhe, Mpiko
AU - Armero, Yolanda
AU - Azqueta, Manuel
AU - Castan~eda, Ximena
AU - Cervera, Carlos
AU - Falces, Carlos
AU - Garcia-de-la-Maria, Cristina
AU - Fita, Guillermina
AU - Gatell, Jose M.
AU - Marco, Francesc
AU - Mestres, Carlos A.
AU - Miro´, Jose´ M.
AU - Moreno, Asuncion
AU - Ninot, Salvador
AU - Pare´, Carlos
AU - Pericas, Joan
AU - Ramirez, Jose
AU - Rovira, Irene
AU - Sitges, Marta
AU - Anguera, Ignasi
AU - Font, Bernat
AU - Guma, Joan Raimon
AU - Bermejo, Javier
AU - Ferna´ndez, Miguel Angel Garcia
AU - Gonzalez-Ramallo, Victor
AU - Mari´n, Mercedes
AU - Mun~oz, Patricia
AU - Pedromingo, Miguel
AU - Roda, Jorge
AU - Rodri´guez-Cre´ixems, Marta
AU - Solis, Jorge
AU - Fernandez-Hidalgo, Nuria
AU - Tornos, Pilar
AU - de Alarco´n, Ari´stides
AU - Parra, Ricardo
AU - Alestig, Eric
AU - Johansson, Magnus
AU - Olaison, Lars
AU - Snygg-Martin, Ulrika
AU - Pachirat, Orathai
AU - Pachirat, Pimchitra
AU - Pussadhamma, Burabha
AU - Senthong, Vichai
AU - Casey, Anna
AU - Elliott, Tom
AU - Lambert, Peter
AU - Watkin, Richard
AU - Eyton, Christina
AU - Klein, John L.
AU - Bradley, Suzanne
AU - Kauffman, Carol
AU - Bedimo, Roger
AU - Crowley, Anna Lisa
AU - Douglas, Pamela
AU - Drew, Laura
AU - Fowler, Vance G.
AU - Holland, Thomas
AU - Mudrick, Daniel
AU - Samad, Zaniab
AU - Sexton, Daniel J.
AU - Stryjewski, Martin
AU - Wang, Andrew
AU - Lerakis, Stamatios
AU - Cantey, Robert
AU - Steed, Lisa
AU - Dickerman, Stuart A.
AU - Bonilla, Hector
AU - DiPersio, Joseph
AU - Salstrom, Sara Jane
AU - Baddley, John
AU - Patel, Mukesh
AU - Peterson, Gail
AU - Stancoven, Amy
AU - Afonso, Luis
AU - Kulman, Theresa
AU - Levine, Donald
AU - Rybak, Michael
AU - Cabell, Christopher H.
AU - Baloch, Khaula
AU - Dixon, Christy C.
AU - Fowler, Vance G.
AU - Harding, Tina
AU - Jones-Richmond, Marian
AU - Park, Lawrence P.
AU - Redick, Thomas
AU - Stafford, Judy
AU - Anstrom, Kevin
AU - Bayer, Arnold S.
AU - Karchmer, A. W.
AU - Durack, David T.
AU - Eykyn, Susannah
AU - Moreillon, Phillipe
PY - 2013/5/17
Y1 - 2013/5/17
N2 - The HACEK organisms (Haemophilus species, Aggregatibacter species, Cardiobacterium hominis, Eikenella corrodens, and Kingella species) are rare causes of infective endocarditis (IE). The objective of this study is to describe the clinical characteristics and outcomes of patients with HACEK endocarditis (HE) in a large multi-national cohort. Patients hospitalized with definite or possible infective endocarditis by the International Collaboration on Endocarditis Prospective Cohort Study in 64 hospitals from 28 countries were included and characteristics of HE patients compared with IE due to other pathogens. Of 5591 patients enrolled, 77 (1.4%) had HE. HE was associated with a younger age (47 vs. 61 years; p<0.001), a higher prevalence of immunologic/vascular manifestations (32% vs. 20%; p<0.008) and stroke (25% vs. 17% p = 0.05) but a lower prevalence of congestive heart failure (15% vs. 30%; p = 0.004), death in-hospital (4% vs. 18%; p = 0.001) or after 1 year follow-up (6% vs. 20%; p = 0.01) than IE due to other pathogens (n = 5514). On multivariable analysis, stroke was associated with mitral valve vegetations (OR 3.60; CI 1.34-9.65; p<0.01) and younger age (OR 0.62; CI 0.49-0.90; p<0.01). The overall outcome of HE was excellent with the in-hospital mortality (4%) significantly better than for non-HE (18%; p<0.001). Prosthetic valve endocarditis was more common in HE (35%) than non-HE (24%). The outcome of prosthetic valve and native valve HE was excellent whether treated medically or with surgery. Current treatment is very successful for the management of both native valve prosthetic valve HE but further studies are needed to determine why HE has a predilection for younger people and to cause stroke. The small number of patients and observational design limit inferences on treatment strategies. Self selection of study sites limits epidemiological inferences.
AB - The HACEK organisms (Haemophilus species, Aggregatibacter species, Cardiobacterium hominis, Eikenella corrodens, and Kingella species) are rare causes of infective endocarditis (IE). The objective of this study is to describe the clinical characteristics and outcomes of patients with HACEK endocarditis (HE) in a large multi-national cohort. Patients hospitalized with definite or possible infective endocarditis by the International Collaboration on Endocarditis Prospective Cohort Study in 64 hospitals from 28 countries were included and characteristics of HE patients compared with IE due to other pathogens. Of 5591 patients enrolled, 77 (1.4%) had HE. HE was associated with a younger age (47 vs. 61 years; p<0.001), a higher prevalence of immunologic/vascular manifestations (32% vs. 20%; p<0.008) and stroke (25% vs. 17% p = 0.05) but a lower prevalence of congestive heart failure (15% vs. 30%; p = 0.004), death in-hospital (4% vs. 18%; p = 0.001) or after 1 year follow-up (6% vs. 20%; p = 0.01) than IE due to other pathogens (n = 5514). On multivariable analysis, stroke was associated with mitral valve vegetations (OR 3.60; CI 1.34-9.65; p<0.01) and younger age (OR 0.62; CI 0.49-0.90; p<0.01). The overall outcome of HE was excellent with the in-hospital mortality (4%) significantly better than for non-HE (18%; p<0.001). Prosthetic valve endocarditis was more common in HE (35%) than non-HE (24%). The outcome of prosthetic valve and native valve HE was excellent whether treated medically or with surgery. Current treatment is very successful for the management of both native valve prosthetic valve HE but further studies are needed to determine why HE has a predilection for younger people and to cause stroke. The small number of patients and observational design limit inferences on treatment strategies. Self selection of study sites limits epidemiological inferences.
UR - http://www.scopus.com/inward/record.url?scp=84877859498&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0063181
DO - 10.1371/journal.pone.0063181
M3 - Article
C2 - 23690995
AN - SCOPUS:84877859498
SN - 1932-6203
VL - 8
JO - PLoS ONE
JF - PLoS ONE
IS - 5
M1 - e63181
ER -