018 NEW FEATURES OF ENDOCARDITIS WITH THE CHANGE OF MILLENNIUM

The aim of this study was to describe the characteristics of HAIE and to establish a comparison between health care and community-acquired episodes. HAIE was defined as either IE manifesting >48 hours after admission to the hospital or IE acquired in association with a significant invasive procedure performed during a stay and/or manipulation in a hospital setting within 6 months before diagnosis. Results: HAIE accounted for 16% of 793 cases. Compared with community-acquired infection, patients with HAIE tended to be older (60.1 vs. 53.6; P= 0.0001) and had more co-morbidities (Charlson index, 3.3 vs. 1.8; P= 0.0001) and staphylococcal infections (58.3% vs. 24.8%). Intra-hospital mortality (44.9 vs. 24.2%) was higher in the HAIE group. Vascular manipulation constituted the main cause of bacteremia responsible for HAIE (63%). Septic shock (OR, 10.13; 95% CI, 3.18 32.12; P= 0.0001) and severe heart failure (OR, 2.79; 95% CI, 1.09 7.13; P= 0.03) were independent predictors of intrahospital mortality in the HAIE cohort. Conclusions: The present study demonstrates that HAIE attacks a fragile population and it is principally caused by microorganisms strongly related to vascular manipulations. Extremely careful management of vascular accesses is needed in order to minimize the risk of secondary bacteraemias.