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Differences between endocarditis caused by Streptococcus bovis and Enterococcus spp. and their association with colorectal cancer

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Abstract

Streptococcus bovis group and Enterococcus spp. share phenotypic characteristics and intestinal habitat. Both have been associated with endocarditis and colorectal neoplasm (CRN). We studied all cases of endocarditis diagnosed between 1988 and 2014 in our centre and caused by S. bovis (109, 48.8 % of the bacteremia) and by Enterococcus spp. (36, 3.4 % of the bacteremia). Patients were seen until death or during a long-term follow-up, in order to rule out a concomitant CRN. The 109 cases of S. bovis endocarditis (SbIE) compared with the 36 caused by enterococci showed: a higher proportion of males (91 % vs. 72 %, p=0.005), more multivalvular involvement (28 % vs. 6 %, p=0.004), embolic complications (44 vs. 22 %, p=0.02) and colorectal neoplasm (64 % vs. 25 %, p=0.001). SbIE showed fewer co-morbidities (32 vs. 58 %, p=0.005), and less frequently urinary infection source (0 vs. 25 %, p=0.001) and healthcare-related infection (2 vs. 44 %, p=0.001). A total of 123 patients were followed up for an extended period (mean: 65.9 ± 57.5 months). During the follow-up, 6 of 28 (21 %) cases with enterococcal endocarditis and 43 of 95 (45.2 %, p=0.01) cases with SbIE developed a new CRN. These neoplasiae appeared a mean of 60.4 months later (range 12-181 months). Among the 43 cases with SbIE and CRN, 12 had had a previously normal colonoscopy and 31 had had a previous CRN and developed a second neoplasm. Cases of SbIE present important differences with those caused by Enterococcus spp. Colonoscopy must be mandatory both in the initial evaluation of SbIE, as during the follow-up period.

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Acknowledgments

We would like to thank J. Ariza, R. Pallarés and C. Somoza for review of the manuscript.

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Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Authors and Affiliations

  1. Infectious Disease Unit, Hospital Universitario Lucus Augusti, Avd. Dr. Ulises Romero s/n, 27003, Lugo, Spain

    J. Corredoira, M. J. García-País, R. Rabuñal & M.J. López-Álvarez

  2. Department of Clinical Microbiology, Hospital Universitario Lucus Augusti, Avd. Dr. Ulises Romero s/n, 27003, Lugo, Spain

    A. Coira, F. García-Garrote, J. Pita, A. Rodríguez-Macías & M. P. Alonso-García

  3. Department Microbiology, Veterinary Faculty, Universidad de Santiago, Lugo, Spain

    M. Blanco

  4. Gastroenterology Unit, Hospital Universitario Lucus Augusti, Lugo, Spain

    L. Lopez-Roses

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  1. J. Corredoira
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  2. M. J. García-País
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  3. A. Coira
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  4. R. Rabuñal
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  9. L. Lopez-Roses
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  11. M. P. Alonso-García
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Correspondence to A. Coira or R. Rabuñal.

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Corredoira, J., García-País, M.J., Coira, A. et al. Differences between endocarditis caused by Streptococcus bovis and Enterococcus spp. and their association with colorectal cancer. Eur J Clin Microbiol Infect Dis 34, 1657–1665 (2015). https://doi.org/10.1007/s10096-015-2402-1

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