Advertisement

Left-sided infective endocarditis caused by Streptococcus agalactiae: rare and serious

  • Radka Ivanova-GeorgievaEmail author
  • Josefa Ruiz-Morales
  • Emilio García-Cabrera
  • María Victoria García-López
  • Juan Gálvez-Acebal
  • Antonio Plata-Ciezar
  • Javier de la Torre Lima
  • Carmen Hidalgo-Tenorio
  • Francisco Javier Martínez-Marcos
  • David Vinuesa García
  • Rafael Luque
  • Arístides de Alarcón González
Original Article

Abstract

A comparative study of the behaviour of left-sided infective endocarditis (left-sided IE) due to Streptococcus agalactiae (GBS) with left-sided IE caused by Staphylococcus aureus (SA). A prospective, multicentre cohort study in eight public hospitals in Spain, from January 1984 to December 2015; comparative analysis and factors associated with mortality. In total, there were 1754 episodes of left-sided IE; 41 (2.3%) caused by GBS vs. 344 (19.6%) due to SA, definitive IE 39 vs. 324 cases, males, 25 vs. 213, respectively. There were no differences in age or comorbidity, and healthcare-associated acquirement was 10% vs. 43%, p 0.001. Transthoracic echocardiogram (TTE) was performed in 95% vs. 96.8% and a transesophageal echocardiogram (TEE) in 61% vs. 56%. Vegetations were detected in 80% and measured > 1 cm in a similar proportion. It affected native valves in 85.4% vs. 82.6% and late prosthetic valve in 14.6% vs. 9.6%. The course was acute in both groups. There were more skin manifestations in SA left-sided IE, 7.3% vs. 32%, p 0.001. Both groups had similar complications, but in SA, there was more renal failure, 24% vs. 45%, p 0.010. Surgical risk and operated patients were similar. Mortality was proportionally higher in the SA group, without significance 29% vs. 43% (150), p 0.09. Heart failure, septic shock and neurological deterioration conditioned mortality: HR 1.96, 1.69 and 1.37 (CI 95% 1.40–2.73; 1.19–2.39 and 0.99–1.88 respectively) and to a lesser degree SA as aetiology agent and age. Left-sided IE caused by GBS is similar in severity to left-sided IE caused by SA.

Keywords

Left-sided infective endocarditis Streptococcus agalactiae Staphylococcus aureus 

Notes

Compliance with ethical standards

All procedures followed were in accordance with the ethical standards. Informed consent was obtained from all patients for being included in the study.

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Gallagher PG, Watanakunakorn CH (1986) Group B streptococcal endocarditis: report of seven cases and review of the literature 1962-1985. Rev Infect Dis 9:175–188CrossRefGoogle Scholar
  2. 2.
    Schully BE, Spriggs D, Neu H (1987) Streptococcus agalactiae (group B) endocarditis. A description of twelve cases and review of the literature. Infection 3:21–23Google Scholar
  3. 3.
    Pringle SD, McCartney AC, Marshall AS, Cobb S (1989) Infective endocarditis caused by Streptococcus agalactiae. Int J Cardiol 24:179–183CrossRefGoogle Scholar
  4. 4.
    Marrón A, Carratalá J, Peña C, Roson B, Tubau F, Rufi G (1997) Endocarditis caused by group B streptococci in adults. Enferm Infecc Microbiol Clin 15:147–150Google Scholar
  5. 5.
    Rollan MJ, San Roman JA, Vilacosta I, Sarria C, Lopez J, Acuña M et al (2003) Clinical profile of Streptococcus agalactiae native valve endocarditis. Am Heart J 146:1095–1098CrossRefGoogle Scholar
  6. 6.
    Rodriguez Granger J, Ruiz Lopez F, Camacho Muñoz E, Turino J, Sanpedro A, Miranda C (2006) Streptococcus agalactiae infective endocarditis. Enferm Infecc Microbiol Clin 24:379–381CrossRefGoogle Scholar
  7. 7.
    Sambola A, Miró JM, Tornos MP, Almirante B, Moreno-Torrico A, Gurgui M et al (2002) Streptococcus agalactiae infective endocarditis: analysis of 30 cases and review of literature 1962-1998. Clin Infect Dis 34:1576–1584CrossRefGoogle Scholar
  8. 8.
    Hurtado-Carrillo L, Hermida JM, Centella T, Dronda F (2008) Infective endocarditis due to Streptococcus agalactiae: clinical profile of an eight-case series. Enferm Infecc Microbiol Clin 26:56–61CrossRefGoogle Scholar
  9. 9.
    Ro A (2016) Streptococcus agalactiae infective endocarditis complicated by large vegetations at aortic valve cups along with intracoronary extension: an autopsy case report. Cardiovasc Pathol:221–224Google Scholar
  10. 10.
    de Chiara B, Peritore A, Sara R, Giannattasio C, Moreo A (2016) Infective endocarditis of an aortic flap due to Streptococcus agalactiae in a patient with Sjögren’s syndrome: an unusual clinical case report. Echocardiography xx:1–2Google Scholar
  11. 11.
    Ivanova Georgieva R, García López MV, Ruiz-Morales J, Martínez-Marcos FJ, Lomas JM, Plata A, Noureddine M, Hidalgo-Tenorio C, Reguera JM, De la Torre Lima J, Gálvez-Aceval J, Márquez M, de Alarcón A, for the Andalusian Group for the Study of Cardiovascular Infections of the Andalusian Society of Infectious Diseases (SAEI) (2010) Streptococcus agalactiae left-sided infective endocarditis. Analysis of 27 cases from a multicentric cohort. J Infect 61:54 5927CrossRefGoogle Scholar
  12. 12.
    Sendi P, Ericsson M, Olaison L (2012) Infective endocarditis caused by group B Streptococcus. The role of aminoglycoside-combination. J Infect 64:127–129CrossRefGoogle Scholar
  13. 13.
    Gálvez-Acebal J, Rodríguez-Baño J, Martínez-Marcos FJ, Reguera JM, Plata A, Ruiz J, Márquez M, Lomas JM, de la Torre-Lima J, Hidalgo-Tenorio C, de Alarcón A, Grupo para el Estudio de las Infecciones Cardiovasculares de la Sociedad Andaluza de Enfermedades Infecciosas (SAEI) (2010) Prognostic factors in left-sided endocarditis: results from the Andalusian multicenter cohort. BMC Infect Dis 10:1–8CrossRefGoogle Scholar
  14. 14.
    Li JS, Sexton DJ, Mick N, Nettles R, Fowler VG Jr, Ryan T et al (2000) Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis 30:633–638CrossRefGoogle Scholar
  15. 15.
    Marín M, Muñoz P, Sanchez M, del Rosal M, Alcalá L, Rodríguez Créixems M, Group for the Management of Infective Endocarditis of the Gregorio Marañón Hospital et al (2007) Molecular diagnosis of infective endocarditis by real-time broad-range polymerase chain reaction (PCR) and sequencing directly from heart valve tissue. Medicine (Baltimore) 86:195–202CrossRefGoogle Scholar
  16. 16.
    Evangelista A, González-Alujas MT (2004) Echocardiography in infective endocarditis. Heart 90:614–617CrossRefGoogle Scholar
  17. 17.
    Ben-Ami R, Giladi M, Carmeli Y, Orni-Wasserlauf R, SiegmanIgra Y (2004) Hospital-acquired infective endocarditis. Should the definition be broadened? Clin Infect Dis 38:843–850CrossRefGoogle Scholar
  18. 18.
    Lomas JM, Martínez-Marcos FJ, Plata A, Ivanova R, Galvez J, Ruiz J et al (2010) Healthcare-associated infective endocarditis: an undesirable effect of healthcare universalization. Clin Microbiol Infect 16:1683–1690CrossRefGoogle Scholar
  19. 19.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383CrossRefGoogle Scholar
  20. 20.
    Ho KK, Pinsky JL, Kannel WB, Levy D (1993) The epidemiology of heart failure: the Framingham study. J Am Coll Cardiol 22:6A–13ACrossRefGoogle Scholar
  21. 21.
    Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup et al (2013) Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 41:580–637CrossRefGoogle Scholar
  22. 22.
    Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG et al (2007) Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 11(2):R31CrossRefGoogle Scholar
  23. 23.
    Roques F, Nashef SA, Michel P, Gauducheau E, de Vincentiis C, Baudet E et al (1999) Risk factors and outcome in European cardiac surgery: analysis of the Euro Score multinational database of 19030 patients. Eur J Cardiothorac Surg 15:816–812CrossRefGoogle Scholar
  24. 24.
    Bamgbola O (2016) Review of vancomycin-induced renal toxicity: an update. Ther Adv Endocrinol Metab 7:136–147CrossRefGoogle Scholar
  25. 25.
    van Hal SJ, Paterson DL, Lodise TP (2013) Systematic review and meta-analysis of vancomycin –induced nephrotoxicity associated with dosing schedules that maintain troughs between 15 and 20 milligrams per liter. Antomicrob Agents Chemoter 57:733–744Google Scholar
  26. 26.
    Satoskar AA, Nadasdy G, Plaza JA, Sedmak D, Shidham G, Hebert L, Nadasdy T (2006) Staphylococcus infection- associated glomerulonephritis mimicking IgA nephropathy. Clin J Am Soc Nephrol:1179–1186Google Scholar
  27. 27.
    Jun-Hua Y-WF, Ynag A-H, Tsai MH (2016) Devastating renal outcome caused by skin infection with methicillin-resistant Stapylococcus aureus. A case report. Medicine 95:26 (e4023)CrossRefGoogle Scholar
  28. 28.
    Fernández-Hidalgo N, Ribera A, Larrosa MN, Vedma E, Origüer J et al (2018) Impact of Staphylococcus aureus phenotype and genotype on the clinical characteristics and outcome of infective endocarditis. A multicentre, longitudinal, prospective, observational study. Clin Microbiol Infect 24(9):985–991CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Radka Ivanova-Georgieva
    • 1
    Email author
  • Josefa Ruiz-Morales
    • 2
  • Emilio García-Cabrera
    • 3
  • María Victoria García-López
    • 4
  • Juan Gálvez-Acebal
    • 5
  • Antonio Plata-Ciezar
    • 6
  • Javier de la Torre Lima
    • 7
  • Carmen Hidalgo-Tenorio
    • 8
  • Francisco Javier Martínez-Marcos
    • 9
  • David Vinuesa García
    • 10
  • Rafael Luque
    • 11
  • Arístides de Alarcón González
    • 11
  1. 1.Servicio de Medicina Interna, Instituto de Investigación Biomédica de Málaga (IBIMA)Hospital Clínico Universitario “Virgen de la Victoria”MálagaSpain
  2. 2.UGC de Enfermedades Infecciosas, Instituto de Investigación Biomédica de Málaga (IBIMA)Hospital Clínico Universitario “Virgen de la Victoria”MálagaSpain
  3. 3.Delos Clinical Clinical Research OrganizationSevilleSpain
  4. 4.Servicio de Microbiologia Clínica, Instituto de Investigación Biomédica de Málaga (IBIMA)Hospital Clínico Universitario “Virgen de la Victoria”MálagaSpain
  5. 5.UGC de Enfermedades Infecciosas, Instituto de Biomedicina de Sevilla, IBiSHospital Universitario Virgen Macarena. CSIC, Universidad de SevillaSevilleSpain
  6. 6.Servicio de Enfermedades InfecciosasHospital Regional Universitario de MálagaMálagaSpain
  7. 7.Grupo de Enfermedades Infecciosas de la Unidad de Medicina InternaHospital Costa del Sol. MarbellaMálagaSpain
  8. 8.UGC de Enfermedades InfecciosasHospital Universitario Virgen de las Nieves, Complejo Hospitalario Universitario de GranadaGranadaSpain
  9. 9.UGC de Enfermedades InfecciosasComplejo Hospitalario Universitario de HuelvaHuelvaSpain
  10. 10.Servicio de Medicina Interna-Enfermedades InfecciosasHospital Clínico San Cecilio-CHUGGranadaSpain
  11. 11.UGC de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Servicio de E. Infecciosas, Instituto de Biomedicina de Sevilla (IBiS)Hospital Universitario Virgen del RocíoSevilleSpain

Personalised recommendations