Epidemiology, bacteriology, and clinical characteristics of HACEK bacteremia and endocarditis: a population-based retros
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ORIGINAL ARTICLE
Epidemiology, bacteriology, and clinical characteristics of HACEK bacteremia and endocarditis: a population-based retrospective study Andreas Berge 1,2
&
Christian Morenius 3
&
Alexandros Petropoulos 4,5
&
Bo Nilson 6,7
&
Magnus Rasmussen 3,8
Received: 18 May 2020 / Accepted: 10 September 2020 # The Author(s) 2020
Abstract 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. Keywords Endocarditis . Bacteremia . HACEK . Epidemiology . Echocardiography . Management score
Introduction Bacteremia constitutes a clinical situation with a risk for different complications, of which infective endocarditis (IE) is of high relevance [1]. Faced with a positive blood culture (BC) result, the clinician has to evaluate the risk of IE and decide on
the diagnostic workup and treatment. For bacteria that are common causes of IE, risk stratification systems to determine the need for transesophageal echocardiography (TEE) in bacteremia have been developed [2–6]. The genera of Haemophilus (except H. influenzae), Aggregatibacter, Cardiobacterium, Eikenella, and Kingella
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10096-020-04035-y) contains supplementary material, which is available to authorized users. * Andreas Berge [email protected] 1
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