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Risk for infective endocarditis in bacteremia with Gram positive cocci

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Abstract

Purpose

Infective endocarditis (IE) is a serious complication of bacteremia and is most often caused by Gram positive cocci. We investigated the prevalence of IE in patients where echocardiography was encouraged when bacteremia with Gram positive cocci was present.

Methods

The study included patients with Gram positive cocci bacteremia hospitalized at two Danish hospitals between March and December 2016. Information concerning echocardiography, demographics and bacterial species was collected from the patients’ medical files. Patients without echocardiography were followed for 6 months in order to confirm or reject possible IE.

Results

The study included 585 patients with Gram positive cocci bacteremia, and echocardiography was performed in 414 (71%) of them. The prevalence of IE in patients with high risk bacteremia, i.e. Staphylococcus aureus, non-beta-hemolytic streptococci, Enterococcus faecalis, and coagulase-negative staphylococci was 16%. Patients with Enterococcus faecalis had the highest prevalence of IE (33%) followed by non-beta-hemolytic streptococci (23%) and Staphylococcus aureus (12%). Among low risk bacteremia the prevalence of IE was 1%. The mean age of patients with IE was 74 years (SD 12.9) and 71% were male.

Conclusion

These findings strongly support routine echocardiography in patients with high risk bacteremia and non-performance of echocardiography in patients with low risk bacteremia.

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References

  1. Cahill TJ, Prendergast BD (2016) Infective endocarditis. Semin 882 www.thelancet.com 387:.

  2. Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications. Circulation. 2015;132:1435–86.

    Article  CAS  Google Scholar 

  3. Murdoch DR, Corey GR, Hoen B, et al. NIH public access: clinical presentation, etiology and outcome of infective endocarditis in the 21st Century: the international collaboration on endocarditis-prospective cohort study. Arch Intern Med. 2013;169:463–73. https://doi.org/10.1001/archinternmed.2008.603.Clinical.

    Article  Google Scholar 

  4. Habib G, Lancellotti P, Antunes MJ, et al (2015) 2015 ESC Guidelines for the management of infective endocarditis.

  5. Le Moing V, Doco-lecompte T, Chirouze C, et al. Preeminence of staphylococcus aureus in infective endocarditis: a 1-year population-based survey. Clin Infect Dis. 2012. https://doi.org/10.1093/cid/cis199.

    Article  Google Scholar 

  6. Muñoz P, Kestler M, De Alarcón A, et al. Current epidemiology and outcome of infective endocarditis: a multicenter, prospective, cohort study. Medicine (United States). 2015;94:1–8. https://doi.org/10.1097/MD.0000000000001816.

    Article  Google Scholar 

  7. Rasmussen RV, Høst U, Arpi M, et al. Prevalence of infective endocarditis in patients with Staphylococcus aureus bacteraemia: the value of screening with echocardiography. Eur J Echocardiogr. 2011. https://doi.org/10.1093/ejechocard/jer023.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Abraham J, Mansour C, Veledar E, et al. Staphylococcus aureus bacteremia and endocarditis: the grady memorial hospital experience with methicillin-sensitive S aureus and methicillin-resistant S aureus bacteremia. Am Heart J. 2004;147:536–9. https://doi.org/10.1016/j.ahj.2003.09.018.

    Article  PubMed  Google Scholar 

  9. Fowler VG, Ralph Corey G, Boley J, et al. Role of echocardiography in evaluation of patients with staphylococcus aureus bacteremia: experience in 103 patients. J Am Coll Cardiol. 1997;30:1072–8.

    Article  Google Scholar 

  10. Dahl A, Lauridsen TK, Arpi M, et al. Risk factors of endocarditis in patients with enterococcus faecalis bacteremia: external validation of the nova score. Clin Infect Dis. 2016;63:771–5. https://doi.org/10.1093/cid/ciw383.

    Article  PubMed  Google Scholar 

  11. Fernández-Guerrero ML, Herrero L, Bellver M, et al. Nosocomial enterococcal endocarditis: a serious hazard for hospitalized patients with enterococcal bacteraemia. J Intern Med. 2002;252:510–5. https://doi.org/10.1046/j.1365-2796.2002.01061.x.

    Article  PubMed  Google Scholar 

  12. Pinholt M, Østergaard C, Arpi M, et al. Incidence, clinical characteristics and 30-day mortality of enterococcal bacteraemia in Denmark 2006–2009: a population-based cohort study. Clin Microbiol Infect. 2014;20:145.

    Article  CAS  Google Scholar 

  13. Bouza E, Kestler M, Beca T, et al. The NOVA score: a proposal to reduce the need for transesophageal echocardiography in patients with enterococcal bacteremia. Clin Infect Dis. 2015;60:528–35. https://doi.org/10.1093/cid/ciu872.

    Article  PubMed  Google Scholar 

  14. Dahl A, Iversen K, Tonder N, et al. Prevalence of Infective endocarditis in enterococcus faecalis bacteremia. J Am Coll Cardiol. 2019;74:193–201. https://doi.org/10.1016/j.jacc.2019.04.059.

    Article  PubMed  Google Scholar 

  15. Tubiana S, Duval X, Alla F, et al. The VIRSTA score, a prediction score to estimate risk of infective endocarditis and determine priority for echocardiography in patients with Staphylococcus aureus bacteremia. J Infect. 2016. https://doi.org/10.1016/j.jinf.2016.02.003.

    Article  PubMed  Google Scholar 

  16. Berge A, Krantz A, Östlund H, et al. The DENOVA score efficiently identifies patients with monomicrobial Enterococcus faecalis bacteremia where echocardiography is not necessary. Infection. 2019;47:45–50. https://doi.org/10.1007/s15010-018-1208-3.

    Article  PubMed  Google Scholar 

  17. Sunnerhagen T, Törnell A, Vikbrant M, et al. HANDOC: a handy score to determine the need for echocardiography in Non-β-hemolytic streptococcal bacteremia. Clin Infect Dis. 2018;66:693–8. https://doi.org/10.1093/cid/cix880.

    Article  PubMed  Google Scholar 

  18. N.E. Bruun, H. Wiggers, H. Elming, C. Moser, J. J. Christensen, S. Gill, N. Ihlemann, J. Helweg-Larsen MS (2017) Danish National Guidelines in treatment of infective endocarditis. http://nbv.cardio.dk/endocarditis#afs7_6. In: Dansk Cardiol. Selsk.

  19. Vos FJ, Bleeker-Rovers CP, Sturm PD, et al. Endocarditis: effects of routine echocardiography during gram-positive bacteraemia. Neth J Med. 2011;69:335–40.

    CAS  PubMed  Google Scholar 

  20. Francioli P, Ruch W, Stamboulian D. Treatment of streptococcal endocarditis with a single daily dose of ceftriaxone and netilmicin for 14 DAYS: a Prospective Multicenter Study Author (s): P. Francioli, W. Ruch, D. Stamboulian and The International Infective Endocarditis Study Group. Clin Infect Dis. 1995;21:1406–10.

    Article  CAS  Google Scholar 

  21. Østergaard L, Bruun NE, Voldstedlund M, et al. Prevalence of infective endocarditis in patients with positive blood cultures: a Danish nationwide study. Eur Heart J. 2019;40:3237–44. https://doi.org/10.1093/eurheartj/ehz327.

    Article  CAS  PubMed  Google Scholar 

  22. Min JK, Spencer KT, Furlong KT, et al. Clinical features of complications from transesophageal echocardiography: a single-center case series of 10,000 consecutive examinations. J Am Soc Echocardiogr. 2005;18:925–9.

    Article  Google Scholar 

  23. Reynolds HR, Jagen MA, Tunick PA. Sensitivity of transthoracic versus transesophageal echocardiography for the detection of native valve vegetations in the modern era. Am Soc Echocardiogr. 2003. https://doi.org/10.1067/mje.2003.43.

    Article  Google Scholar 

  24. Kini V, Logani S, Ky B, et al. Transthoracic and transesophageal echocardiography for the indication of suspected infective endocarditis: vegetations, blood cultures and imaging. J Am Soc Echocardiogr. 2010;23:396–402. https://doi.org/10.1016/j.echo.2009.12.017.

    Article  PubMed  Google Scholar 

  25. Bayer A. Transesophageal echocardiography in diagnosis of infective endocarditis. Chest. 1994. https://doi.org/10.1378/chest.105.2.377.

    Article  PubMed  Google Scholar 

  26. Shively BK, Gurule FT, Roldan CA, et al. Clinical studies: diagnostic value of transesophageal compared with transthoracic echocardiography in infective endocarditis. Am Coll Cardiol. 1991. https://doi.org/10.1016/0735-1097(91)90591-V.

    Article  Google Scholar 

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Acknowledgements

We thank the clinical microbiologists from the Department of Clinical Microbiology at Herlev-Gentofte Hospital for helping us identify patients with Gram positive bacteremia hospitalized in the included hospitals during the study period.

Funding

This work was supported by the Department of Cardiology at Herlev-Gentofte Hospital, Denmark.

Author information

Authors and Affiliations

  1. Department of Cardiology, Herlev-Gentofte hospital, University of Copenhagen, Herlev Ringvej 75, Herlev, 2730, Copenhagen, Denmark

    Malene Højgaard Andersen, Sarah Louise Kjølhede Holle, Christine Falk Klein & Kasper Karmark Iversen

  2. Department of Clinical Microbiology, Herlev-Gentofte Hospital, University of Copenhagen, Herlev Ringvej 75, Herlev, 2730, Copenhagen, Denmark

    Magnus Arpi

  3. Department of Cardiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen East, Denmark

    Henning Bundgaard

  4. Department of Cardiology, Nordsjaellands Hospital, University of Copenhagen, Dyrehavevej 29, Hilleroed, 3400, Copenhagen, Denmark

    Niels Tønder

  5. Department of Cardiology, Zealand University Hospital, Roskilde, Denmark

    Niels Eske Bruun

  6. Clinical Institute, University of Copenhagen, Copenhagen, Denmark

    Niels Eske Bruun

  7. Clinical Institute, University of Aalborg, Aalborg, Denmark

    Niels Eske Bruun

Authors
  1. Malene Højgaard Andersen
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  2. Sarah Louise Kjølhede Holle
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Corresponding authors

Correspondence to Malene Højgaard Andersen or Kasper Karmark Iversen.

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Conflict of interest

All authors: none declared.

Ethics approval

The study was performed in accordance with the Declaration of Helsinki and was approved by the Danish Data Protection Agency (j.nr.: 2012-58-0004 (3-3013-1845/1)).

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Andersen, M.H., Holle, S.L.K., Klein, C.F. et al. Risk for infective endocarditis in bacteremia with Gram positive cocci. Infection 48, 905–912 (2020). https://doi.org/10.1007/s15010-020-01504-6

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  • DOI: https://doi.org/10.1007/s15010-020-01504-6

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