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Virulence of beta-hemolytic streptococci in infective endocarditis

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Abstract

Background

Streptococci involved in infective endocarditis (IE) primarily comprise alpha- or non-hemolytic streptococci (ANHS). Moreover, beta-hemolytic streptococci (BHS) can be involved, and guidelines recommend the addition of gentamicin for the first 2 weeks of treatment and the consideration of early surgery in such cases. This study compared the morbidity and mortality associated with IE depending on the microorganisms involved (BHS, ANHS, staphylococci, and enterococci).

Methods

We conducted a retrospective observational study between 2012 and 2017 in a single hospital in France. The endpoints were overall in-hospital mortality, 1-year mortality and the occurrence of complications.

Results

We analyzed 316 episodes of definite IE including 150 (38%), 96 (25%), 46 (12%), and 24 cases (6%) of staphylococcal, ANHS, enterococcal, and BHS IE, respectively. In-hospital mortality was significantly higher in the staphylococcal (n = 40; 26.7%) and BHS groups (n = 6; 25.0%) than in the ANHS (n = 9; 9.4%) and enterococcal groups (n = 5; 10.9%) (all p < 0.01). The rates of septic shock and cerebral emboli were also higher in the BHS group than in the ANHS group [n = 7 (29.2%) vs. n = 3 (3.1%), p < 0.001; n = 7 (29.2%) vs. n = 12 (12.5%); p = 0.05, respectively].

Conclusion

This study confirmed that BHS IE has a more severe prognosis than ANHS IE. The virulence of BHS may be similar to that of staphylococci, justifying increased monitoring of these patients and more ‘aggressive’ treatments such as early surgery.

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References

  1. Slipczuk L, Codolosa JN, Davila CD, Romero-Corral A, Yun J, Pressman GS, et al. Infective endocarditis epidemiology over five decades: a systematic review. PLoS One. 2013;8:e82665.

    Article  Google Scholar 

  2. Duval X, Delahaye F, Alla F, Tattevin P, Obadia J-F, Le Moing V, et al. Temporal trends in infective endocarditis in the context of prophylaxis guideline modifications: three successive population-based surveys. J Am Coll Cardiol. 2012;59:1968–76.

    Article  Google Scholar 

  3. Sy RW, Kritharides L. Health care exposure and age in infective endocarditis: results of a contemporary population-based profile of 1536 patients in Australia. Eur Heart J. 2010;31:1890–7.

    Article  Google Scholar 

  4. Murdoch DR, Corey GR, Hoen B, Miró JM, Fowler VG, Bayer AS, et al. Clinical presentation, etiology and outcome of infective endocarditis in the 21st century: the international collaboration on endocarditis-prospective cohort study. Arch Intern Med. 2009;169:463–73.

    Article  Google Scholar 

  5. Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta J-P, Del Zotti F, et al. ESC guidelines for the management of infective endocarditis: the Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J. 2015;36:3075–128.

    Article  Google Scholar 

  6. Baddour LM, Wilson WR, Bayer AS, Fowler VG, Tleyjeh IM, Rybak MJ, et al. Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the american heart association. Circulation. 2015;132:1435–86.

    Article  CAS  Google Scholar 

  7. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA. 2016;315:801–10.

    Article  CAS  Google Scholar 

  8. Baddour LM. Infective endocarditis caused by beta-hemolytic streptococci. The infectious diseases society of America’s emerging infections network. Clin Infect Dis. 1998;26:66–71.

    Article  CAS  Google Scholar 

  9. Lefort A, Lortholary O, Casassus P, Selton-Suty C, Guillevin L, Mainardi J-L, et al. Comparison between adult endocarditis due to beta-hemolytic streptococci (serogroups A, B, C, and G) and Streptococcus milleri: a multicenter study in France. Arch Intern Med. 2002;162:2450–6.

    Article  Google Scholar 

  10. Ekelund K, Skinhøj P, Madsen J, Konradsen HB. Invasive group A, B, C and G streptococcal infections in Denmark 1999–2002: epidemiological and clinical aspects. Clin Microbiol Infect. 2005;11:569–76.

    Article  CAS  Google Scholar 

  11. Rantala S, Vuopio-Varkila J, Vuento R, Huhtala H, Syrjänen J. Clinical presentations and epidemiology of beta-haemolytic streptococcal bacteraemia: a population-based study. Clin Microbiol Infect. 2009;15:286–8.

    Article  CAS  Google Scholar 

  12. Oppegaard O, Mylvaganam H, Kittang BR. Beta-haemolytic group A, C and G streptococcal infections in Western Norway: a 15-year retrospective survey. Clin Microbiol Infect. 2015;21:171–8.

    Article  CAS  Google Scholar 

  13. El Rafei A, DeSimone DC, DeSimone CV, Lahr BD, Steckelberg JM, Sohail MR, et al. Beta-haemolytic streptococcal endocarditis: clinical presentation, management and outcomes. Infect Dis. 2016;48:373–8.

    Article  Google Scholar 

  14. Sambola A, Miro JM, Tornos MP, Almirante B, Moreno-Torrico A, Gurgui M, et al. Streptococcus agalactiae infective endocarditis: analysis of 30 cases and review of the literature, 1962–1998. Clin Infect Dis. 2002;34:1576–84.

    Article  CAS  Google Scholar 

  15. Rollán MJ, San Román JA, Vilacosta I, Sarriá C, López J, Acuña M, et al. Clinical profile of Streptococcus agalactiae native valve endocarditis. Am Heart J. 2003;146:1095–8.

    Article  Google Scholar 

  16. Ivanova-Georgieva R, Ruiz-Morales J, García-Cabrera E, García-López MV, Gálvez-Acebal J, Plata-Ciezar A, et al. Left-sided infective endocarditis caused by Streptococcus agalactiae: rare and serious. Eur J Clin Microbiol Infect Dis. 2019;38:265–75.

    Article  Google Scholar 

  17. Olmos C, Vilacosta I, Sarriá C, López J, Ferrera C, Sáez C, et al. Streptococcus bovis endocarditis: update from a multicenter registry. Am Heart J. 2016;171:7–13.

    Article  Google Scholar 

  18. Bläckberg A, Nilson B, Özenci V, Olaison L, Rasmussen M. Infective endocarditis due to Streptococcus dysgalactiae: clinical presentation and microbiological features. Eur J Clin Microbiol Infect Dis. 2018;37:2261–72.

    Article  Google Scholar 

  19. Wang A, Athan E, Pappas PA, Fowler VG, Olaison L, Paré C, et al. Contemporary clinical profile and outcome of prosthetic valve endocarditis. JAMA. 2007;297:1354–61.

    Article  CAS  Google Scholar 

  20. Mahesh B, Angelini G, Caputo M, Jin XY, Bryan A. Prosthetic valve endocarditis. Ann Thorac Surg. 2005;80:1151–8.

    Article  Google Scholar 

  21. Sendi P. Infective endocarditis caused by Streptococcus agalactiae: time for beta-hemolytic streptococci to follow treatment recommendations for S. aureus? Eur J Clin Microbiol Infect Dis. 2019;38:419–22.

    Article  Google Scholar 

  22. Selton-Suty C, Célard M, Le Moing V, Doco-Lecompte T, Chirouze C, Iung B, et al. Preeminence of Staphylococcus aureus in infective endocarditis: a 1-year population-based survey. Clin Infect Dis. 2012;54:1230–9.

    Article  Google Scholar 

  23. Day MD, Gauvreau K, Shulman S, Newburger JW. Characteristics of children hospitalized with infective endocarditis. Circulation. 2009;119:865–70.

    Article  Google Scholar 

  24. Weidman DR, Al-Hashami H, Morris SK. Two cases and a review of Streptococcus pyogenes endocarditis in children. BMC Pediatr. 2014;14:227.

    Article  Google Scholar 

  25. Chu VH, Park LP, Athan E, Delahaye F, Freiberger T, Lamas C, et al. Association between surgical indications, operative risk, and clinical outcome in infective endocarditis: a prospective study from the International Collaboration on Endocarditis. Circulation. 2015;131:131–40.

    Article  Google Scholar 

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Acknowledgements

We thank François Lefebvre for his help in the statistical analysis. The authors would like to thank Enago (www.enago.com) for the English language review.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Infectious Disease, Strasbourg University Hospital, Strasbourg, France

    Yvon Ruch, Yves Hansmann, Nicolas Lefebvre, Nawal Douiri, Aurélie Martin & Xavier Argemi

  2. Laboratory of Bacteriology, Strasbourg University Hospital, Strasbourg, France

    Philippe Riegel

  3. Department of Cardiovascular Surgery, Strasbourg University Hospital, Strasbourg, France

    Jean-Philippe Mazzucotelli

  4. Service de Maladies Infectieuses et Tropicales, Centre Hospitalo, Universitaire de Strasbourg, 1 place de l’hôpital, BP 426, 67091, Strasbourg Cedex, France

    Yvon Ruch

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  1. Yvon Ruch
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  2. Yves Hansmann
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  3. Philippe Riegel
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  4. Nicolas Lefebvre
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  5. Jean-Philippe Mazzucotelli
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Contributions

YR, XA, and YH designed the study. YR, XA, YH, AM, NL, ND, and JPM collected the data. YR and XA analyzed the data. PR analyzed the microbiological data. YR performed the statistical analysis. YR and XA wrote the manuscript. All authors reviewed, revised, and approved the final report.

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Correspondence to Yvon Ruch.

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Ruch, Y., Hansmann, Y., Riegel, P. et al. Virulence of beta-hemolytic streptococci in infective endocarditis. Infection 48, 91–97 (2020). https://doi.org/10.1007/s15010-019-01358-7

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