Infective Endocarditis Due to Non-HACEK Gram-Negative Bacilli: Clinical Characteristics and Risk Factors from A Prospective Multicenter Brazilian Cohort

Abstract BackgroundThe aim of this study is to describe the clinical characteristics of patients with infective endocarditis (IE) due to non-HACEK Gram-negative bacilli (NGNB) and the risk factors associated with mortality in a large multicentre cohort.MethodsThis prospective observational study included consecutive patients with definitive IE diagnosed according to the modified Duke criteria in Brazil between 2006 and 2019. Patients with blood or heart valve cultures positive with NGNB were identified and studied.ResultsOf 1154 adult patients with definite IE enrolled, 38 (3.29%) had IE due to NGNB. Median age was 57 (IQR, 43-69) years. Most common etiologies were Pseudomonas aeruginosa and Klebsiella spp. (8 episodes, 21% each). IE was associated with a higher prevalence of embolic events 21/38(72.4%). Chronic renal failure 18/38(44.7%), prosthetic valves 19/38(50%) and device-related IE 6/8(15.8%) were common. 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; p = 0.017), haemodialysis (OR 16.2; 95% CI, 1.78 to 147; p = 0.008) and chronic kidney disease (OR 4.8; 95% IC, 1.2 to 19.1, p = 0.049) were identified as risk factors associated with mortality, but not multidrug-resistant microorganisms.ConclusionsThe rate of IE due to NGNB was similar to that in previous studies. Enterobacterales and P. aeruginosa were the most common etiologies. NGNB IE was associated with the presence of central venous catheters, prosthetic valves, intracardiac devices and haemodialysis and had a high mortality rate.