Epidemiology, bacteriology, and clinical characteristics of HACEK bacteremia and endocarditis: a population-based retrospective study.
The objective was to describe the epidemiology, bacteriology, clinical presentation, risk factors for endocarditis (IE), diagnostic workup, and outcome of patients with bacteremia caused by the non-influenzae Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, and Kingella genera (HACEK). A retrospective population-based cohort of patients with bacteremia collected from 2012 to 2017 was identified. Clinical data from identified patients were collected from medical records to classify patients, calculate incidences, analyze risk factors of IE, and describe the management and outcome of the cohort. A total of 118 episodes of HACEK bacteremia were identified, of which 27 were definite IE. The incidence of HACEK bacteremia was 5.2 and of HACEK IE 1.2 episodes per 1,000,000 inhabitants per year. Other focal infections were identified in 55 of 118 of the episodes, most commonly within the abdomen (26 episodes). The propensity to cause IE ranged from 62 in Aggregatibacter actinomycetemcomitans to 6% in Eikenella. Risk factors for IE were cardiac implantable electronical device, predisposing cardiac conditions, community acquisition, long duration of symptoms, multiple positive blood cultures, fever, heart murmur, embolization, and unknown origin of infection. The scoring system DENOVA developed to predict IE in bacteremia with Enterococcus faecalis also had a high sensitivity and specificity for predicting IE in HACEK bacteremia. The 30-day mortality was 4% in IE and 15% in non-IE bacteremia, and only one case of relapse was found. IE is common in bacteremia with Aggregatibacter, Cardiobacterium, and Kingella but relatively rare in Haemophilus and Eikenella. Treatment failures are very rare, and DENOVA can be used to evaluate the need for transesophageal echocardiography.
['Berge|Andreas|A|http://orcid.org/0000-0002-9561-6814', 'Morenius|Christian|C|https://orcid.org/0000-0003-0591-1113', 'Petropoulos|Alexandros|A|https://orcid.org/0000-0001-7570-6532', 'Nilson|Bo|B|https://orcid.org/0000-0002-8103-4856', 'Rasmussen|Magnus|M|https://orcid.org/0000-0003-1588-5473']
D000328:Adult D000368:Aged D000900:Anti-Bacterial Agents D016470:Bacteremia D001419:Bacteria D004697:Endocarditis, Bacterial D005260:Female D006801:Humans D015994:Incidence D008297:Male D008826:Microbial Sensitivity Tests D008875:Middle Aged D012189:Retrospective Studies D012307:Risk Factors D012720:Severity of Illness Index D013548:Sweden D016896:Treatment Outcome
Epidemiology HACEK Bacteremia Endocarditis Echocardiography Management score