Amandine Périer1, Mathieu Puyade1, Matthieu Revest2, Pierre Tattevin2, Louis Bernard3, Adrien Lemaignen3, David Boutoille4, Joseph Allal5, France Roblot6, Blandine Rammaert7. 1. Université de Poitiers, Poitiers, France; CHU de Poitiers, Service de Médecine Interne, Poitiers, France. 2. Université de Rennes, Rennes, France; CHU de Pontchaillou, Service de Maladies Infectieuses, Rennes, France. 3. Université de Tours, Tours, France; CHRU de Tours, Hôpital Bretonneau, Service de Médecine Interne et Maladies Infectieuses, Tours, France. 4. Université de Nantes, Nantes, France; CHU de Nantes, Service de Maladies Infectieuses, Nantes, France. 5. Université de Poitiers, Poitiers, France; CHU de Poitiers, Service de Cardiologie, Poitiers, France. 6. Université de Poitiers, Poitiers, France; CHU de Poitiers, Service de maladies infectieuses et tropicales, Poitiers, France; Inserm U1070, Poitiers, France. 7. Université de Poitiers, Poitiers, France; CHU de Poitiers, Service de maladies infectieuses et tropicales, Poitiers, France; Inserm U1070, Poitiers, France. Electronic address: blandine.rammaert.paltrie@univ-poitiers.fr.
Abstract
BACKGROUND: Streptococcus pneumoniae is responsible for <2% of infective endocarditis (IE). The aim of this study was to assess the prognosis of pneumococcal IE. METHODS: This multicentric observational retrospective study included adult patients presenting with definite S. pneumoniae IE according to modified Dukes criteria from four French university hospitals over a 15-year period, January 2000-December 2015. Survival rate at 90 days and 2 years after diagnosis, appropriateness of antibiotherapy, and pneumococcal vaccination status were determined. Risk factors for mortality were studied by univariate analysis. RESULTS: Of 3886 patients admitted with IE during the study period, 50 (1.3%) had pneumococcal IE, mostly males (n = 38, 76%), with a mean age of 60 ± 14 years. Predisposing conditions for IE or for invasive pneumococcal disease (IPD) involved 24% and 78% of the cases, respectively. Only 2 patients were vaccinated against pneumococcus before IE and 13 (26%) after IE. Antimicrobial strategy was in accordance with the 2015 ESC Guidelines in 28%. Cardiac surgery was performed in 56%, and was associated with better survival (p = 0.012). In the 40 patients followed until 2 years, the survival rate was 67%, deaths occurring mostly before 90 days. Age ≥ 65 was a risk factor for mortality (p = 0.011). CONCLUSION: Pneumococcal IE remains rare but with a poor prognosis. Resort to surgery is yet to be determined. Predisposing conditions for IPD are the main factors leading to pneumococcal IE. They could be prevented by vaccine coverage improvement.
BACKGROUND:Streptococcus pneumoniae is responsible for <2% of infective endocarditis (IE). The aim of this study was to assess the prognosis of pneumococcal IE. METHODS: This multicentric observational retrospective study included adult patients presenting with definite S. pneumoniae IE according to modified Dukes criteria from four French university hospitals over a 15-year period, January 2000-December 2015. Survival rate at 90 days and 2 years after diagnosis, appropriateness of antibiotherapy, and pneumococcal vaccination status were determined. Risk factors for mortality were studied by univariate analysis. RESULTS: Of 3886 patients admitted with IE during the study period, 50 (1.3%) had pneumococcal IE, mostly males (n = 38, 76%), with a mean age of 60 ± 14 years. Predisposing conditions for IE or for invasive pneumococcal disease (IPD) involved 24% and 78% of the cases, respectively. Only 2 patients were vaccinated against pneumococcus before IE and 13 (26%) after IE. Antimicrobial strategy was in accordance with the 2015 ESC Guidelines in 28%. Cardiac surgery was performed in 56%, and was associated with better survival (p = 0.012). In the 40 patients followed until 2 years, the survival rate was 67%, deaths occurring mostly before 90 days. Age ≥ 65 was a risk factor for mortality (p = 0.011). CONCLUSION:Pneumococcal IE remains rare but with a poor prognosis. Resort to surgery is yet to be determined. Predisposing conditions for IPD are the main factors leading to pneumococcal IE. They could be prevented by vaccine coverage improvement.