Beta-Hemolytic Streptococcal Infective Endocarditis: Characteristics and Outcomes From a Large, Multinational Cohort

Abstract Background Beta-hemolytic streptococci (BHS) are an uncommon cause of infective endocarditis (IE). The aim of this study was to describe the clinical features and outcomes of patients with BHS IE in a large multinational cohort and compare them with patients with viridans streptococcal IE. Methods The International Collaboration on Endocarditis Prospective Cohort Study (ICE-PCS) is a large multinational database that recruited patients with IE prospectively using a standardized data set. Sixty-four sites in 28 countries reported patients prospectively using a standard case report form developed by ICE collaborators. Results Among 1336 definite cases of streptococcal IE, 823 were caused by VGS and 147 by BHS. Patients with BHS IE had a lower prevalence of native valve (P < .005) and congenital heart disease predisposition (P = .002), but higher prevalence of implantable cardiac device predisposition (P < .005). Clinically, they were more likely to present acutely (P < .005) and with fever (P = .024). BHS IE was more likely to be complicated by stroke and other systemic emboli (P < .005). The overall in-hospital mortality of BHS IE was significantly higher than that of VGS IE (P = .001). In univariate analysis, variables associated with in-hospital mortality for BHS IE were age (odds ratio [OR], 1.044; P = .004), prosthetic valve IE (OR, 3.029; P = .022), congestive heart failure (OR, 2.513; P = .034), and stroke (OR, 3.198; P = .009). Conclusions BHS IE is characterized by an acute presentation and higher rate of stroke, systemic emboli, and in-hospital mortality than VGS IE. Implantable cardiac devices as a predisposing factor were more often found in BHS IE compared with VGS IE.

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1048. Beta-Hemolytic Streptococcal Infective Endocarditis: Characteristics and Outcomes From a Large, Multi-National Cohort

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.885 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S313-S313

Author(s):

Nuria Fernandez-Hidalgo ◽

Amal Gharamti ◽

María Luisa Aznar ◽

Vivian H Chu ◽

Hussein Rizk ◽

...

Keyword(s):

Infective Endocarditis ◽

Hospital Mortality ◽

High Rate ◽

National Database ◽

Case Report Form ◽

Viridans Streptococci ◽

Cardiac Device ◽

Data Set ◽

Standard Case ◽

National Cohort

Abstract Background β-Hemolytic streptococci (BHS) are an uncommon cause of infective endocarditis (IE). The aim of this study was to describe the clinical features and outcomes of patients with β-hemolytic streptococcal infective endocarditis in a large multi-national cohort, and compare them to patients with oral Viridans IE, a more common cause of IE. Methods The International Collaboration on Endocarditis Prospective Cohort Study (ICE-PCS) is a large multi-national database that recruited patients with IE prospectively using a standardized data set. Sixty-four sites in 28 countries reported patients prospectively using a standard case report form (CRF) developed by ICE collaborators. Patients with BHS IE were compared with patients with IE due to Oral Viridans Streptococci (OVS). Results Among 1336 cases of streptococcal IE, 823 (62%) were caused by OVS and 147 (11%) by BHS. The majority of patients in both groups belonged to the male gender and had similar median age. Among the predisposing conditions, congenital heart disease and native valve predisposition were more commonly associated with OVS IE than with BHS IE (P < 0.005). The presence of endocavitary cardiac device is associated more with BHS IE than with OVS IE (P = 0.026). BHS were more likely to be penicillin-susceptible than OVS (P = 0.001). Clinically, patients with BHS IE are more likely to present acutely (P < 0.005) and with fever (P = 0.024). BHS IE is more likely to be complicated by stroke (P < 0.005) and other systemic embolism (P < 0.005). The overall in-hospital mortality of BHS IE was significantly higher than that of OVS IE (P = 0.001). The independent factors associated with in-hospital mortality for β-hemolytic streptococcal IE were age, per 1-year increment (OR 1.044; CI 1.014–1.075; P = 0.004) and prosthetic valve IE (OR 3.029; CI 1.171–7.837; P = 0.022). The complications associated with a higher in-hospital mortality were CHF (OR 2.513; CI 1.074–5.879; P = 0.034), especially CHF NYHA III or IV (OR 4.136; CI 1.707–10.025; P = 0.002), and stroke (OR 3.198; CI 1.343–7.619; P = 0.009). Conclusion Our findings suggest that BHS IE is an aggressive disease characterized by an acute presentation. It is associated with a significant rate of complications and a high rate of in-hospital mortality. This underlines the importance of early surgery to prevent the progression of disease. Disclosures All authors: No reported disclosures.

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18F-FDG PET/CT in Infective Endocarditis: Indications and Approaches for Standardization

Current Cardiology Reports ◽

10.1007/s11886-021-01542-y ◽

2021 ◽

Vol 23 (9) ◽

Author(s):

D. ten Hove ◽

R.H.J.A. Slart ◽

B. Sinha ◽

A.W.J.M. Glaudemans ◽

R.P.J. Budde

Keyword(s):

Infective Endocarditis ◽

Fdg Pet ◽

Prosthetic Valve Endocarditis ◽

Cardiac Device ◽

Native Valve ◽

Prosthetic Valves ◽

Cardiac Devices ◽

Pet Ct ◽

Fdg Pet Ct ◽

Disseminated Disease

Abstract Purpose of Review Additional imaging modalities, such as FDG-PET/CT, have been included into the workup for patients with suspected infective endocarditis, according to major international guidelines published in 2015. The purpose of this review is to give an overview of FDG-PET/CT indications and standardized approaches in the setting of suspected infective endocarditis. Recent Findings There are two main indications for performing FDG-PET/CT in patients with suspected infective endocarditis: (i) detecting intracardiac infections and (ii) detection of (clinically silent) disseminated infectious disease. The diagnostic performance of FDG-PET/CT for intracardiac lesions depends on the presence of native valves, prosthetic valves, or implanted cardiac devices, with a sensitivity that is poor for native valve endocarditis and cardiac device-related lead infections, but much better for prosthetic valve endocarditis and cardiac device-related pocket infections. Specificity is high for all these indications. The detection of disseminated disease may also help establish the diagnosis and/or impact patient management. Summary Based on current evidence, FDG-PET/CT should be considered for detection of disseminated disease in suspected endocarditis. Absence of intracardiac lesions on FDG-PET/CT cannot rule out native valve endocarditis, but positive findings strongly support the diagnosis. For prosthetic valve endocarditis, standard use of FDG-PET/CT is recommended because of its high sensitivity and specificity. For implanted cardiac devices, FDG-PET/CT is also recommended, but should be evaluated with careful attention to clinical context, because its sensitivity is high for pocket infections, but low for lead infections. In patients with prosthetic valves with or without additional aortic prosthesis, combination with CTA should be considered. Optimal timing of FDG-PET/CT is important, both during clinical workup and technically (i.e., post tracer injection). In addition, procedural standardization is key and encompasses patient preparation, scan acquisition, reconstruction, subsequent analysis, and clinical interpretation. The recommendations discussed here will hopefully contribute to improved standardization and enhanced performance of FDG-PET/CT in the clinical management of patients with suspected infective endocarditis.

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The 3 noes right-sided infective endocarditis: a unrecognized type of right-sided endocarditis

European Heart Journal ◽

10.1093/ehjci/ehaa946.2022 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

J Lopez Diaz ◽

I Vilacosta ◽

G Habib ◽

J.M Miro ◽

C Olmos ◽

...

Keyword(s):

Infective Endocarditis ◽

Hospital Mortality ◽

Drug Users ◽

Univariate Analysis ◽

Right Heart Failure ◽

Cardiac Devices ◽

The Right ◽

First Time ◽

Prognostic Profile ◽

Worse Prognosis

Abstract Introduction The “3 noes right-sided infective endocarditis” (3no-RSIE: no left-sided, no drug users, no cardiac devices) was depicted for the first time more than a decade ago. We describe the largest series to date to characterize its clinical, microbiological, echocardiographic and prognostic profile. Methods Eight tertiary centers with surgical facilities participated in this study. Patients with right-sided endocarditis without left involvement, absence of antecedents of drug use and no intracardiac electronic devices were retrospectively included in a multipurpose database. A total of 53 variables were analysed in every patient. We performed a univariate analysis of in-hospital mortality to determine variables associated with worse prognosis. Results A total of 100 patients (mean age 54.1±20 years, 65% male) with definite 3no-RSIE were included (16.7% of all the right-sided endocarditis of the series). Most of the episodes were community-acquired (72%), congenital cardiopathies were frequent, fever was the main manifestation at admission (85%). The microbiological profile is led by Staphylococci spp. Vegetations were detected in 92% of the patients. Global in-hospital mortality was 19% (5.7% in patients operated and 26% in patients who received only medical treatment, p<0.001). Non community-acquired infection, diabetes mellitus, right heart failure, septic shock and acute renal failure were more common in patients who died. Conclusions The clinical profile of 3no-RSIE is closer to other types of RSIE than to LSIE, but mortality is higher than that reported on for other types of RSIE. Surgery plays an important role in improving outcome. Funding Acknowledgement Type of funding source: None

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472 Epidemiology and temporal trends of cardiac device related infective endocarditis

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.251 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

M Denes ◽

A Bence ◽

T Ferenci ◽

S Borbas ◽

Z Som ◽

...

Keyword(s):

Infective Endocarditis ◽

Temporal Trends ◽

Mortality Rates ◽

Coagulase Negative Staphylococcus ◽

Cardiac Device ◽

Native Valve ◽

Tertiary Referral Center ◽

Device Implantation ◽

Epidemiological Characteristics ◽

Over Time

Abstract Background Infective endocarditis (IE) is a rare, but life-threatening complication of cardiac device implantation. Despite recent preventive strategies, and advances in antimicrobial and surgical treatment, morbidity and mortality rates are still high. Aims The objective of our study was to assess the epidemiological characteristics, temporal tends and mortality rate of cardiac device related IE (CDRIE) in our high-volume, tertiary referral center. Methods retrospective data collection was performed from January 1, 2006 to December 31, 2016. Thirty-day, 6-month and 1-year mortality was estimated, which were compared to left-sided native valve endocarditis (LSNIE). Patients administered between 2006 and 2010 and between 2011 and 2016 were compared to assess temporal trends. Results 465 cases of IE were administered, out of whom 54 patients had CDRIE (39 males [72%], mean age: 55.8 ±19 yrs; 4 VVI, 7 VDD, 7 VVI-ICD, 20 DDD, 5 DDD-ICD and 11 CRT devices; median time since first implantation: 1558 days [IQR: 470 days – 8.6 yrs]). The infection was caused by streptococci in 3 cases (5.5%), Staphylococci were the most prevalent infective agents (70%), S. aureus (SA) in 28 cases (52%, out of whom 10 were MRSA), coagulase negative Staphylococcus in 10 cases (18.5%), blood culture negative cases in 8 patients (15%), and in 5 cases other pathogens were responsible. 266 patients had LSNIE (201 males [75%], mean age: 54.4 ± 15.6 yrs). There was no difference between the two groups in age or in portion of males. Mortality rates were the same in CDRIE group compared to LSNIE group (30-day: 13% vs 13%, 6-month: 20% vs 25%, 1-year: 26% vs 29% and long-term: 44% vs 44%, ns resp.) Patients who died in the CDRIE group (n = 25) were older (64 yrs [IQR:59-71 yrs] vs 52 yrs [IQR: 27-69 yrs], p = 0.02), male sex was less common (52% vs 79%, p = 0.03), had lower ejection fraction (39.6 ±16.6% vs 54.6 ±14.5%, p < 0.001), had worse renal function (GFR: 46.3 ± 15.3 vs 60.2 ± 23.5 ml/min/1.73m2, p = 0.04), shorter time since first device implantation (2.1 yrs [IQR: 1.1-4.8 yrs] vs 6.7 yrs [4.1-12.9 yrs], p = 0.006), and CRT device implantation were more prevalent (32% vs 10%, p < 0.05). Patients admitted before 2011 (n = 22) did not differ from patients admitted after 2011 (n = 32) in terms of age, male gender, concomitant valve infection, pocket infection, or embolic event. The 30-day (0% vs 6%) and the 1-year mortality (18% vs 31%) were the same before and after 2011, but the 6-month mortality was better before 2011 (4.5% vs 31%, p = 0.01). CRT device implantation was more prevalent over time (5% vs 31%, p = 0.01), and SA infection became more frequent (36% vs 63%, p = 0.05) Conclusions During the last decade patients with CDRIE had a same survival as patients with LSNIE, every fourth patient died one year after the diagnosis. Almost three-quarter of the infections were caused by Staphylococci, and the portion of S. aureus infection increased over time.

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Prevalence of infective endocarditis in streptococcal bloodstream infections is dependent on streptococcal species

European Heart Journal ◽

10.1093/ehjci/ehaa946.2015 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Chamat ◽

A Dahl ◽

L Oestergaard ◽

M Arpi ◽

E Fosboel ◽

...

Keyword(s):

Infective Endocarditis ◽

Public Hospital ◽

Bloodstream Infections ◽

Population Based ◽

University Hospital ◽

Multivariable Logistic Regression Analysis ◽

Funding Source ◽

Cardiac Device ◽

Native Valve ◽

Streptococcal Species

Abstract Background Streptococci frequently cause infective endocarditis (IE), yet the prevalence of IE in patients with bloodstream infections (BSIs) caused by different streptococcal species is unknown. Purpose To investigate the prevalence of IE in BSIs with different streptococcal species. Methods We included all patients with streptococcal BSIs, from 2008 to 2017, in a population-based setup. Based on microbiological identification of phylogenetic relationship, streptococcal species were classified into eight main groups: Anginosus, Bovis, Mitis, Mutans, Salivarius, Pyogenic, S. pneumoniae, and “other streptococci”. Using nationwide registries, we determined the prevalence of IE at streptococcal group level and at species level. In a multivariable logistic regression analysis, we investigated the risk of IE according to streptococcal species with S. pneumoniae as reference and adjusted for age, sex, ≥3 positive blood culture (BC) bottles, native valve disease, prosthetic valve, previous IE, and cardiac device. Results In 6,506 cases with streptococcal BSIs (mean age 68.1 years (SD 16.2), 52.8% men), the IE prevalence was 7.1% (95% CI: 6.5–7.8%). For the most common streptococcal species (>5% of BSIs), the IE prevalence was: S. pneumoniae 1.2% (95% CI: 0.8–1.6%), S. dysgalactiae 6.4% (95% CI: 4.9–8.2%), S. pyogenes 1.9% (95% CI: 0.9–3.3%), S. agalactiae 9.1% (95% CI: 6.6–12.1%), S. anginosus 4.8% (95% CI: 3.0–7.3%), and S. mitis/oralis 19.4% (95% CI: 15.6–23.5%) (Figure 1). For moderately common streptococcal species (1–5% of BSIs), the IE prevalence was: S. gallolyticus 30.2% (95% CI: 24.3–36.7%), S. salivarius 5.8% (95% CI: 2.9–10.1%), S. sanguinis 34.6% (95% CI: 26.6–43.3%), S. parasanguinis 10.3% (95% CI: 5.2–17.7), and S. gordonii 44.2% (95% CI: 34.0–54.8%). For uncommon streptococcal species (0.1–1% of BSIs), the highest IE prevalence was in S. mutans with 47.9% (95% CI: 33.3–62.8%). In a multivariable adjusted analysis using S. pneumoniae as a reference, we identified that all species except S. pyogenes were associated with a significantly higher IE risk (Figure 1). The highest associated IE risk was found in S. mutans (OR 81.3, 95% CI: 37.6–176), S. gordonii (OR 80.8, 95% CI: 43.9–149), S. sanguinis (OR 59.1, 95% CI: 32.6–107), S. gallolyticus (OR 31.0, 95% CI: 18.8–51.1), and S. mitis/oralis (OR 31.6, 95% CI: 19.8–50.5) (Figure 1). Conclusion The prevalence of IE in streptococcal BSIs is highly species dependent with the lowest IE prevalence observed in S. pneumoniae and S. pyogenes BSIs, whereas S. mutans, S. gordonii, S. sanguinis, S. gallolyticus and S. mitis/oralis had the highest IE prevalence and the highest associated IE risk after adjusting for IE risk factors. Figure 1. Risk of IE in streptococcal BSIs Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Herlev-Gentofte University Hospital

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Isolated Native Tricuspid Valve Endocarditis in a Nonintravenous Drug User

Case Reports in Cardiology ◽

10.1155/2020/8812597 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Habtewold Shibru ◽

Ermias shenkutie Greffie ◽

Zenahbezu Abay ◽

Oumer Abdu Muhie

Keyword(s):

Infective Endocarditis ◽

Tricuspid Valve ◽

Drug Users ◽

High Morbidity ◽

Central Venous ◽

Cardiac Device ◽

Rural Ethiopia ◽

Cardiac Devices ◽

Underlying Risk ◽

Tricuspid Valve Endocarditis

Infective endocarditis (IE) is a disease characterized by high morbidity and mortality. IE was first described in the mid-16th century. Right-sided infective endocarditis (RSIE) represents 5% to 10% of all IE episodes in adults. RSIE can be divided into three groups according to the underlying risk factors: intravenous drug users (IDUs), cardiac device carriers, and the “three noes” group (no left-sided IE, no IDUs, and no cardiac devices). Tricuspid valve endocarditis in nonintravenous drug users can occur in a variety of conditions including congenital heart disease, intracardiac devices, central venous catheters, and immunologically debilitated patients. Due to the rareness of isolated native nonrheumatic tricuspid valve endocarditis, here, we like to present an 18-year-old male from rural Ethiopia with the diagnosis of isolated native tricuspid valve endocarditis that was treated and cured.

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Contemporary epidemiology and outcomes in recurrent infective endocarditis

Heart ◽

10.1136/heartjnl-2019-315433 ◽

2019 ◽

Vol 106 (8) ◽

pp. 596-602 ◽

Cited By ~ 3

Author(s):

Afonso B Freitas-Ferraz ◽

Gabriela Tirado-Conte ◽

Isidre Vilacosta ◽

Carmen Olmos ◽

Carmen Sáez ◽

...

Keyword(s):

Infective Endocarditis ◽

Hospital Mortality ◽

Prosthetic Valve ◽

Late Complication ◽

Tertiary Care ◽

First Episode ◽

Native Valve ◽

Fourfold Increase ◽

Group I ◽

Group Ii

ObjectiveRecurrent infective endocarditis (IE) is a major complication of patients surviving a first episode of IE. This study sought to analyse the current state of recurrent IE in a large contemporary cohort.Methods1335 consecutive episodes of IE were recruited prospectively in three tertiary care centres in Spain between 1996 and 2015. Episodes were categorised into group I (n=1227), first-IE episode and group II (n=108), recurrent IE (8.1%). After excluding six patients, due to lack of relevant data, group II was subdivided into IIa (n=87), reinfection (different microorganism), and IIb (n=15), relapse (same microorganism within 6 months of the initial episode).ResultsThe cumulative burden and incidence of recurrence was slightly lower in the second decade of the study (2006–2015) (7.17 vs 4.10 events/100 survivors and 7.51% vs 3.82, respectively). Patients with reinfections, compared with group I, were significantly younger, had a higher frequency of HIV infection, were more commonly intravenous drug users (IVDU) and prosthetic valve carriers, had less embolic complications and cardiac surgery, with similar in-hospital mortality. IVDU was found to be an independent predictor of reinfection (HR 3.92, 95% CI 1.86 to 8.28).In the relapse IE group, prosthetic valve endocarditis (PVE) and periannular complications were more common. Among patients treated medically, those with PVE had a higher relapse incidence (4.82% vs 0.43% in native valve IE, p=0.018). Staphylococcus aureus and PVE were independent predictors of relapse (HR 3.14, 95% CI 1.11 to 8.86 and 3.19, 95% CI 1.13 to 9.00, respectively) and in-hospital-mortality was similar to group I. Three-year all-cause mortality was similar in recurrent episodes compared with single episodes.ConclusionRecurrent IE remains a frequent late complication. IVDU was associated with a fourfold increase in the risk of reinfection. PVE treated medically and infections caused by S. aureus increased the risk of relapse. In-hospital and long-term mortality was comparable among groups.

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687. Use of Dalbavancin in Gram-positive Infective Endocarditis: Review of Current Literature

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.884 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S446-S446

Author(s):

Tasaduq Fazili ◽

Ekta Bansal ◽

Mariana Gomez de la Espriella ◽

Dorothy C Garner

Keyword(s):

Infective Endocarditis ◽

Adverse Events ◽

English Language ◽

Case Reports ◽

Kidney Injury ◽

Length Of Hospital Stay ◽

Sequential Therapy ◽

Gram Positive ◽

Cardiac Device ◽

Native Valve

Abstract Background Dalbavancin is a long acting, semisynthetic derivative of teicoplanin that is currently approved for treatment of acute bacterial skin and skin structure infections. Its efficacy and role of in the treatment of invasive infections, in particular infective endocarditis, is not well known. Methods We reviewed the English-language literature for the use of Dalbavancin in the treatment of endocarditis due to Gram-positive organisms, using Pubmed. Results 15 publications were reviewed. All the publications were retrospective in nature, with relatively small numbers of patients, including a few case reports. A total of 159 patients received Dalbavancin for endocarditis. The mean age was 47 years. The main reasons for using Dalbavancin were non-feasibility of a standard outpatient regimen (mainly due to drug use) or the need for a simpler regimen. 75 patients had infection of a native valve, 44 of a prosthetic valve and 19 of a cardiac device. The type of infection for the rest of the patients was not specified. The tricuspid valve was the most frequently reported. The etiologic organisms causing endocarditis were Staphylococcus species, followed by Streptococcus species and Enterococcus species, with Staphylococcus aureus being the most common. All, but one, patients received Dalbavancin as sequential therapy, after receiving other intravenous antibiotics initially. The duration of antibiotics received prior to initiation of Dalbavancin was variable, with the median being 3 weeks. The median duration of Dalbavancin use was 2.7 weeks. The dosage regimens varied, with the more common ones using a loading dose of either 1500 mg or 1000 mg, followed by one or more weekly doses of 500 mg. The overall clinical efficacy was around 89%. Adverse events were mild, including nausea, vomiting, rash, headache and reversible acute kidney injury. None of the patients had to discontinue the drug because of adverse events. Two publications evaluated the cost effectiveness of Dalbavancin and found it to save about &9000 per patient, the saving being mainly due to reduced length of hospital stay. Conclusion Dalbavancin appears to be an efficacious, safe and cost-effective option for sequential treatment of endocarditis caused by Staph aureus and other Gram-positive organisms. Disclosures All Authors: No reported disclosures

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Presumptive Treatment of Malaria in Ghana: Was It Ever Useful? Evidence from the Kassena-Nankana District of Northern Ghana

Malaria Research and Treatment ◽

10.1155/2018/3408089 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6

Author(s):

Michael N. K. Babayara ◽

Bright Addo

Keyword(s):

Secondary Data ◽

Northern Ghana ◽

Routine Practice ◽

Case Report Form ◽

Malaria Parasitaemia ◽

Presumptive Treatment ◽

Malaria Parasites ◽

Data Set ◽

Standard Case ◽

Blood Smears

Background. The WHO currently advocates parasitological confirmation of malaria before treatment is commenced. However, many arguments have emerged both for and against this new position. To contribute to the debate, this secondary data analysis was conducted to determine the likelihood of malaria parasitaemia in a child presenting with fever, vomiting, or cough in the Kassena-Nankana District. Methods. The dataset for this analysis was generated during a study to assess the incidence and risk factors for paediatric rotavirus diarrhoea in the Kassena-Nankana District. Over a two-year period, trained field staff recruited 2086 subjects with episodes of diarrhoea aged 24 months or below into the study. A standard case report form was used to collect data on histories of illness, symptoms, vaccination, and anthropometry. Blood smears were tested for malaria parasites. The data set generated was obtained, cleaned, and analysed using Epi Info version 7.1.1.14 statistical software. Results. Of the 2086 subjects recruited, 2078 had blood smears done and 54.0% had malaria parasites. Fever and vomiting appeared to be associated with parasitaemia with odds ratios of 1.9 (95% CI: 1.5586–2.2370) and 1.2 (95% CI: 1.0352–1.4697), respectively. Cough however appeared protective with an odds ratio of 0.8 (95% CI: 0.6910–0.9765). The odds of parasitaemia appeared to increase where a child presented with more than one symptom. Conclusion. Nearly half (46%) of the subjects in this study presented with symptoms but had no malaria. Presumptive treatment of malaria may therefore be useful in situations where diagnostic tests are not readily available, its routine practice should however not be encouraged.

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Prevalence of Infective Endocarditis in Streptococcal Bloodstream Infections Is Dependent on Streptococcal Species

Circulation ◽

10.1161/circulationaha.120.046723 ◽

2020 ◽

Vol 142 (8) ◽

pp. 720-730 ◽

Cited By ~ 1

Author(s):

Sandra Chamat-Hedemand ◽

Anders Dahl ◽

Lauge Østergaard ◽

Magnus Arpi ◽

Emil Fosbøl ◽

...

Keyword(s):

Infective Endocarditis ◽

Odds Ratio ◽

Prosthetic Valve ◽

Multivariable Analysis ◽

Bloodstream Infections ◽

Species Level ◽

Multivariable Logistic Regression Analysis ◽

Cardiac Device ◽

Native Valve ◽

Streptococcal Species

Background: Streptococci frequently cause infective endocarditis (IE), yet the prevalence of IE in patients with bloodstream infections (BSIs) caused by different streptococcal species is unknown. We aimed to investigate the prevalence of IE at species level in patients with streptococcal BSIs. Methods: We investigated all patients with streptococcal BSIs, from 2008 to 2017, in the Capital Region of Denmark. Data were crosslinked with Danish nationwide registries for identification of concomitant hospitalization with IE. In a multivariable logistic regression analysis, we investigated the risk of IE according to streptococcal species adjusted for age, sex, ≥3 positive blood culture bottles, native valve disease, prosthetic valve, previous IE, and cardiac device. Results: Among 6506 cases with streptococcal BSIs (mean age 68.1 years [SD 16.2], 52.8% men) the IE prevalence was 7.1% (95% CI, 6.5–7.8). The lowest IE prevalence was found with Streptococcus pneumoniae ( S pneumoniae ) 1.2% (0.8–1.6) and Spyogenes 1.9% (0.9–3.3). An intermediary IE prevalence was found with Sanginosus 4.8% (3.0–7.3), Ssalivarius 5.8% (2.9–10.1), and Sagalactiae 9.1% (6.6–12.1). The highest IE prevalence was found with Smitis/oralis 19.4% (15.6–23.5), Sgallolyticus (formerly Sbovis ) 30.2% (24.3–36.7), Ssanguinis 34.6% (26.6–43.3), Sgordonii 44.2% (34.0–54.8), and Smutans 47.9% (33.3–62.8). In multivariable analysis using S pneumoniae as reference, all species except S pyogenes were associated with significantly higher IE risk, with the highest risk found with S gallolyticus odds ratio (OR) 31.0 (18.8–51.1), S mitis/oralis OR 31.6 (19.8–50.5), S sanguinis OR 59.1 (32.6–107), S gordonii OR 80.8 (43.9–149), and S mutans OR 81.3 (37.6–176). Conclusions: The prevalence of IE in streptococcal BSIs is species dependent with S mutans, S gordonii, S sanguinis, S gallolyticus , and S mitis/oralis having the highest IE prevalence and the highest associated IE risk after adjusting for IE risk factors.

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