IDSA’s Emerging Infections Network



IDSA Emerging Infections Network Preliminary Report for

Periodic Query on “Endocarditis Potpourri”

• 894 physicians received queries, and 381 (43%) responded as of 9/23/05;

4 respondents were unable to provide unique or relevant data [n = 377 ]

| |# EIN Members Responding |

|Region | |

|New England |26 |

|Mid Atlantic |55 |

|EN Central |49 |

|WN Central |19 |

|S Atlantic |77 |

|ES Central |25 |

|WS Central |33 |

|Mountain |25 |

|Pacific |64 |

|US Territories |1 |

|Canada |3 |

|Total |377 |

• 344 (91%) EIN members reported seeing approximately 138,544 (range: 1-2000; avg: 403) inpatient consults last year.

• Question One: 341 (90%) EIN respondents reported that since August 1, 2004, they had encountered approximately 4698 patients with infective endocarditis.

Of those, 324 EIN respondents who completed this part of Question One, they estimated that the percent of infective endocarditis cases with Prosthetic Valve Endocarditis (PVE) ranged from 0 to 80% with an average of 15%.

• Question Two: 156 (41%) EIN respondents reported that since August 1, 2004, they had encountered approximately 330 patients with culture-negative endocarditis.

• Question Three: 145 (38%) EIN respondents reported that since August 1, 2004, they had encountered approximately 303 cases of endocarditis caused by the following:

|Organism |# of EIN Members Reporting |Approximate # of Total Cases |

| |Cases | |

|Abiotrophia spp. |21 |23 |

|Bartonella spp. |13 |14 |

|Brucella spp. |4 |3 |

|Chlamydia spp. |4 |5 |

|Coxiella burnetti |10 |12 |

|HACEK organism |69 |95 |

|Legionella spp. |2 |4 |

|Mycoplasma hominis |1 |1 |

|Tropheryma whippelii |3 |2 |

|Other* |71 |144 |

* Of the 71 EIN respondents who indicated that “other” organisms caused endocarditis in their patients since August 1, 2004, 51 listed the “usual suspects” – various staphylococci, streptococci, and enterococci. In addition, a number of members listed the following unusual organisms (# of respondents):

Aerococcus (1)

Aspergillus (3)

Bifidobacterium (1)

Candida spp. (8)

Candida albicans (2)

Candida glabrata (1)

Candida tropicalis (1)

Fungi [not otherwise delineated] (2)

Gemella (1)

Histoplasmosis (1)

Histoplasma capsulatum (2)

Mycobacterium chelonei (1)

Pasteurella multocida (1)

Propionibacterium acnes (1)

Rothia (1)

Stomatococcus (1)

• Question Four: 299 (79%) EIN respondents reported that when attempting to diagnose endocarditis due to the following agents, they would perform the following tests:

|# of EIN Members |

|Agent |Serology |Culture w/Special Handling |PCR or Other Molecular Techniques |

| | |blood |valve |blood |valve |

|Bartonella spp. |219 |145 |94 |73 |81 |

|Brucella spp. |213 |201 |112 |20 |21 |

|Chlamydia spp. |164 |63 |44 |65 |55 |

|Coxiella burnetti |230 |65 |43 |37 |48 |

|Legionella spp. |171 |138 |111 |46 |36 |

|Mycoplasma hominis |123 |90 |68 |41 |42 |

|Tropheryma whippelii |76 |46 |36 |97 |101 |

• Question Five: 59 (16%) EIN respondents reported that since August 1, 2004, they had encountered approximately 88 cases of endocarditis cause by vancomycin-resistant E. faecium with the following details*:

Valves Affected: Aortic - 33

Mitral - 29

Tricuspid - 2

Antimicrobial Regimens: Daptomycin - 9

Daptomycin & another agent - 5

Linezolid - 25

Linezolid & another agent - 7

Synercid - 2

Synercid & another agent - 3

Some combination of Daptomycin/Linezolid/Synercid - 11

Other - 7

Patient Outcomes: Positive (alive/survived/favorable/cure/recovered) - 35

Negative (dead/poor/failed) - 24

Unknown - 9

Mentioned Surgery - 5

* not all respondents provided details

• Questions on Survey Topic:

MD -- Could someone give us an update on what molecular techniques/PCR/cultures are available for these different organisms. It would be nice to have a table with organisms & testing that is available.

HI -- What is availability of tests for above pathogens & what is recommended?

FL -- Where are you submitting blood or tissue specimens for PCR or other molecular techniques in the work-up of your culture negative endocarditis cases?

NY -- How are they treating VRE IE that is Aminoglycoside resistant?

• Additional Comments on Survey Topic:

CA -- I think the new AHA endocarditis guideline published in Circulation is worth a careful reading. I don't agree with absolutely everything it says, but it's very detailed and an excellent guideline. There are a number of changes from prior guidelines.

IL -- Pediatric ID. Virtually no endocarditis now that congenital anomalies corrected so early. Many line infections or complications of line infection loosely called endocarditis by others, not considered endocarditis by me.

OR -- Mycobacteria austroafricanum endocarditis 6/04

TX -- Our cardiologists are generally resistant to perform TEE's and we are therefore, at times, less certain about our diagnoses.

GA -- At my hosiptals the surgeons are not aware of the low rate of infection persisting in a prosthetic valve put into a patient newly on therapy for native valve IE. I think we need to get the word out.

RI -- We are inundated in our IE with MRSA, many related to infected PICC lines

WI -- since more TEE being done more false pos. tests and more evaluations for culture negative endocarditis

CA -- most of above PCR tests are not available at our institution & reference labs don't perform.

PA -- almost all of our endocarditis is Staph aureus

CA -- Very recent (4 weeks) dramatic increase in number of Strep viridans endocarditis cases

NM -- Special handling is no longer necessary for Brucella, Abiotrophia & old HACEK organisms - current blood culture media w/o supplements in modern systems grows these in 2-5 days

TN -- I have an unusual practice limited to transplant patients, non-HIV immunocompromised hosts, and patients with LVADs awaiting heart transplant therefore my experience is quite skewed. All of my endocarditis patients had hospital acquired, line related disease.

DC -- all of our patients with VRE were on hemodialysis to the best of my recollection

OH -- My partner in practice has seen 2 cases of patients with vegetations meeting no other criteria for endocarditis who did well without treatment

TX -- Seeing increasing incidence of MRSA native valve endocarditis especially in HD patients, often associated with CVC.

GA -- I think that the number of Coag Neg Staph endocarditis cases in native valves has gone up quite a bit.

TX -- Most common one I saw was secondary to MSSA, then MRSA, then viridans strep, 2 with Candida in blood cx but with concomitant MRSA in one, Pseudomonas in the other. One case of blood cx (+) for lactobacillus (?).

VA -- Thanks for valuable clinical info from the network!

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