Sylvain A Lother1, Davinder S Jassal2, Philippe Lagacé-Wiens3, Yoav Keynan4. 1. Section of Internal Medicine, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, BMSB 507, Department of Medical Microbiology, 745 Bannatyne Ave, Winnipeg, Manitoba R3E0J9, Canada. Electronic address: sylvain.lother@alumni.ubc.ca. 2. Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, St. Boniface General Hospital, 409 Taché Avenue, Winnipeg, Manitoba R2H2A6, Canada. Electronic address: djassal@sbgh.mb.ca. 3. Department of Medical Microbiology, University of Manitoba and Diagnostic Services Manitoba, L4025, 409 Taché Avenue, Winnipeg, Manitoba R2H2A6, Canada. Electronic address: plagacewiens@dsmanitoba.ca. 4. Section of Infectious Diseases, Departments of Internal Medicine, Medical Microbiology, and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, BMSB 507, Department of Medical Microbiology, 745 Bannatyne Ave, Winnipeg, Manitoba R3E0J9, Canada. Electronic address: Yoav.Keynan@umanitoba.ca.
Abstract
OBJECTIVES: The aim of this study was to determine the incidence of infective endocarditis (IE) in patients with bacteremia caused by group C and group G streptococci (GCGS) and to characterize the burden of disease, clinical characteristics, and outcomes through a case series of patients with GCGS IE. METHODS: Individuals with blood cultures growing GCGS in Manitoba, Canada, between January 2012 and December 2015 were included. Clinical and echocardiographic parameters were collected retrospectively. IE was suspected or confirmed according to the modified Duke criteria. RESULTS: Two hundred and nine bacteremic events occurred in 198 patients. Transthoracic echocardiography (TTE) was performed in 33%. Suspected or confirmed IE occurred in 6% of all patients and in 18% of those with TTE. Native valve infection was more common than prosthetic valve and device-related infections (75%, 17%, and 8%, respectively). Metastatic infection was observed in 64%, primarily to the lungs (57%), skin (43%), osteoarticular system (29%), and central nervous system (29%). Sepsis occurred in 58% and streptococcal toxic shock syndrome in 50% of those with IE, with overall mortality of 17%. CONCLUSIONS: IE from GCGS bacteremia is common and is frequently associated with severe disease, embolic events, and mortality. In the appropriate clinical context, GCGS bacteremic events should prompt investigation for IE.
OBJECTIVES: The aim of this study was to determine the incidence of infective endocarditis (IE) in patients with bacteremia caused by group C and group G streptococci (GCGS) and to characterize the burden of disease, clinical characteristics, and outcomes through a case series of patients with GCGS IE. METHODS: Individuals with blood cultures growing GCGS in Manitoba, Canada, between January 2012 and December 2015 were included. Clinical and echocardiographic parameters were collected retrospectively. IE was suspected or confirmed according to the modified Duke criteria. RESULTS: Two hundred and nine bacteremic events occurred in 198 patients. Transthoracic echocardiography (TTE) was performed in 33%. Suspected or confirmed IE occurred in 6% of all patients and in 18% of those with TTE. Native valve infection was more common than prosthetic valve and device-related infections (75%, 17%, and 8%, respectively). Metastatic infection was observed in 64%, primarily to the lungs (57%), skin (43%), osteoarticular system (29%), and central nervous system (29%). Sepsis occurred in 58% and streptococcal toxic shock syndrome in 50% of those with IE, with overall mortality of 17%. CONCLUSIONS: IE from GCGS bacteremia is common and is frequently associated with severe disease, embolic events, and mortality. In the appropriate clinical context, GCGS bacteremic events should prompt investigation for IE.