Infective endocarditis by Acinetobacter species: a systematic review

Abstract

A. baumannii – A. calcoaceticus complex infections are increasingly frequent, especially in intensive care units. Such infections are associated with a mortality that can be as high as 62%. On the other hand, infective endocarditis (IE) is an uncommon disease with notable morbidity and mortality. Even though IE is rarely caused by Acinetobacter species, these infections can be particularly problematic due to increasing antimicrobial resistance. The purpose of this study was to systemically review all published cases of IE by Acinetobacter species in the literature. A systematic review of PubMed, Scopus and Cochrane library (through 25 April 2020) for studies providing epidemiological, clinical, microbiological as well as treatment data and outcomes of IE by Acinetobacter species was performed. A total of 35 studies, containing data of 37 patients, were included. A prosthetic valve was present in 40.5%, while the most common causative pathogen was A. baumannii – A. calcoaceticus complex, followed by A. lwoffii. Aortic valve was the commonest infected site, followed by mitral valve. Diagnosis was set with transthoracic echocardiography in 48.6%, while the diagnosis was set at autopsy in 20%. Fever and sepsis were the commonest clinical presentations, followed by heart failure and embolic phenomena. Aminoglycosides, cephalosporins and carbapenems were the commonest antimicrobials used. Clinical cure was noted in 70.3%, while overall mortality was 32.4%. Development of heart failure was independently associated with mortality by IE. This systematic review thoroughly describes IE by Acinetobacter and provides information on epidemiology, clinical presentation, treatment and outcomes.

Keywords:

• Endocarditis;
• systematic review;
• Acinetobacter
• baumannii
• calcoaceticus
• antimicrobial susceptibility

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Petros Ioannou MD, MSc, PhD is an internal medicine registrar in the Internal Medicine Department of the University Hospital of Heraklion, Crete, Greece.

Vasiliki Mavrikaki, MD is a chief resident in the Internal Medicine Department of the University Hospital of Heraklion, Crete, Greece.

Diamantis P. Kofteridis, MD, PhD is an associate professor of Internal Medicine in the Faculty of Medicine in the University of Crete, and head of the COVID-19 Department in the University Hospital of Heraklion, Crete, Greece.