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Secular trends in the epidemiology and clinical characteristics of Enterococcus faecalis infective endocarditis at a referral center (2007–2018)

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Abstract

The aim of the study was to analyze the epidemiological and clinical changes in EFIE. All definite IE episodes treated at a referral center between 2007 and 2018 were registered prospectively, and a trend test was used to study etiologies over time. EFIE cases were divided into three periods, and clinical differences between them were analyzed. All episodes of E. faecalis monomicrobial bacteremia (EFMB) between 2010 and 2018 and the percentage of echocardiograms performed were retrospectively collected. Six hundred forty-eight IE episodes were studied. We detected an increase in the percentage of EFIE (15% in 2007, 25.3% in 2018, P = 0.038), which became the most prevalent causative agent of IE during the last study period. One hundred and eight EFIE episodes were analyzed (2007–2010, n = 30; 2011–2014, n = 22; 2015–2018, n = 56). The patients in the last period were older (median 70.9 vs 66.5 vs 76.3 years, P = 0.015) and more frequently had an abdominal origin of EFIE (20% vs 13.6% vs 42.9%, P = 0.014), fewer indications for surgery (63.3% vs 54.6% vs 32.1%, P = 0.014), and non-significantly lower in-hospital mortality (30% vs 18.2% vs 12.5%, P = 0.139). There was an increase in the percentage of echocardiograms performed in patients with EFMB (30% in 2010, 51.2% in 2018, P = 0.014) and EFIE diagnoses (15% in 2010, 32.6% in 2018, P = 0.004). E. faecalis is an increasing cause of IE in our center, most likely due to an increase in the percentage of echocardiograms performed. The factors involved in clinical changes in EFIE should be thoroughly studied.

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Acknowledgments

L. Escolà-Vergé has a Río Hortega contract in the call 2018 Strategic Action Health from Instituto de Salud Carlos III of Spanish Health Ministry for the years 2019-2020.

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Authors and Affiliations

  1. Infectious Diseases Department, Hospital Universitari Vall d’Hebron, Passeig de la Vall d’Hebron 119-129, 08035, Barcelona, Spain

    Laura Escolà-Vergé, Nuria Fernández-Hidalgo & Benito Almirante

  2. Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain

    Laura Escolà-Vergé, Nuria Fernández-Hidalgo & Benito Almirante

  3. Spanish Network for the Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain

    Laura Escolà-Vergé, Nuria Fernández-Hidalgo, María Nieves Larrosa & Benito Almirante

  4. Microbiology Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain

    María Nieves Larrosa

  5. Echocardiography Laboratory, Cardiology Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain

    Ruben Fernandez-Galera

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  1. Laura Escolà-Vergé
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  2. Nuria Fernández-Hidalgo
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  3. María Nieves Larrosa
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  4. Ruben Fernandez-Galera
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  5. Benito Almirante
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Correspondence to Nuria Fernández-Hidalgo.

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The authors declare that they have no conflict of interest.

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This study was approved by the ethics committee of HUVH [PR(AG)356/2019]. Informed consent to participate and to publish from patients was not required according to the ethics committee.

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Escolà-Vergé, L., Fernández-Hidalgo, N., Larrosa, M.N. et al. Secular trends in the epidemiology and clinical characteristics of Enterococcus faecalis infective endocarditis at a referral center (2007–2018). Eur J Clin Microbiol Infect Dis 40, 1137–1148 (2021). https://doi.org/10.1007/s10096-020-04117-x

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