Anders Dahl1, Kasper Iversen2, Niels Tonder3, Nis Hoest4, Magnus Arpi5, Morten Dalsgaard2, Mahtab Chehri6, Lars L Soerensen2, Soren Fanoe7, Soeren Junge8, Ulla Hoest8, Nana Valeur4, Trine K Lauridsen2, Emil Fosbol9, Thomas Hoi-Hansen2, Niels E Bruun10. 1. Department of Cardiology, Herlev Gentofte University Hospital, Copenhagen, Denmark; Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark. Electronic address: anders.dahl@regionh.dk. 2. Department of Cardiology, Herlev Gentofte University Hospital, Copenhagen, Denmark. 3. Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark. 4. Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark. 5. Department of Clinical Microbiology, Herlev Gentofte University Hospital, Copenhagen, Denmark. 6. Department of Clinical Microbiology, Hvidovre University Hospital, Hvidovre, Denmark. 7. Department of Cardiology, Hvidovre University Hospital, Hvidovre, Denmark. 8. Department of Cardiology, University Hospital Glostrup, Glostrup, Denmark. 9. Department of Cardiology, Hvidovre University Hospital, Hvidovre, Denmark; Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark. 10. Department of Cardiology, Herlev Gentofte University Hospital, Copenhagen, Denmark; Department of Cardiology, Zealand University Hospital, Roskilde, Denmark; Clinical Institute, Copenhagen University, Copenhagen, Denmark; Clinical Institute, Aalborg University Hospital, Aalborg, Denmark.
Abstract
BACKGROUND: Enterococcus faecalis is the third most frequent cause of infective endocarditis (IE). Despite this, no systematic prospective echocardiography studies have examined the prevalence of IE in patients with E. faecalis bacteremia. OBJECTIVES: This study sought to determine the prevalence of IE in patients with E. faecalis bacteremia. The secondary objective was to identify predictors of IE. METHODS: From January 1, 2014, to December 31, 2016, a prospective multicenter study was conducted with echocardiography in consecutive patients with E. faecalis bacteremia. Predictors of IE were assessed using multivariate logistic regression with backward elimination. RESULTS: A total of 344 patients with E. faecalis bacteremia were included, all examined using echocardiography, including transesophageal echocardiography in 74% of the cases. The patients had a mean age of 74.2 years, and 73.5% were men. Definite endocarditis was diagnosed in 90 patients, resulting in a prevalence of 26.1 ± 4.6% (95% confidence interval [CI]). Risk factors for IE were prosthetic heart valve (odds ratio [OR]: 3.93; 95% CI: 1.76 to 8.77; p = 0.001), community acquisition (OR: 3.35; 95% CI: 1.74 to 6.46; p < 0.001), ≥3 positive blood culture bottles (OR: 3.69; 95% CI: 1.88 to 7.23; p < 0.001), unknown portal of entry (OR: 2.36; 95% CI: 1.26 to 4.40; p = 0.007), monomicrobial bacteremia (OR: 2.73; 95% CI: 1.23 to 6.05; p = 0.013), and immunosuppression (OR: 2.82; 95% CI: 1.20 to 6.58; p = 0.017). CONCLUSIONS: This study revealed a high prevalence of 26% definite IE in patients with E. faecalis bacteremia, suggesting that echocardiography should be considered in all patients with E. faecalis bacteremia.
BACKGROUND:Enterococcus faecalis is the third most frequent cause of infective endocarditis (IE). Despite this, no systematic prospective echocardiography studies have examined the prevalence of IE in patients with E. faecalis bacteremia. OBJECTIVES: This study sought to determine the prevalence of IE in patients with E. faecalis bacteremia. The secondary objective was to identify predictors of IE. METHODS: From January 1, 2014, to December 31, 2016, a prospective multicenter study was conducted with echocardiography in consecutive patients with E. faecalis bacteremia. Predictors of IE were assessed using multivariate logistic regression with backward elimination. RESULTS: A total of 344 patients with E. faecalis bacteremia were included, all examined using echocardiography, including transesophageal echocardiography in 74% of the cases. The patients had a mean age of 74.2 years, and 73.5% were men. Definite endocarditis was diagnosed in 90 patients, resulting in a prevalence of 26.1 ± 4.6% (95% confidence interval [CI]). Risk factors for IE were prosthetic heart valve (odds ratio [OR]: 3.93; 95% CI: 1.76 to 8.77; p = 0.001), community acquisition (OR: 3.35; 95% CI: 1.74 to 6.46; p < 0.001), ≥3 positive blood culture bottles (OR: 3.69; 95% CI: 1.88 to 7.23; p < 0.001), unknown portal of entry (OR: 2.36; 95% CI: 1.26 to 4.40; p = 0.007), monomicrobial bacteremia (OR: 2.73; 95% CI: 1.23 to 6.05; p = 0.013), and immunosuppression (OR: 2.82; 95% CI: 1.20 to 6.58; p = 0.017). CONCLUSIONS: This study revealed a high prevalence of 26% definite IE in patients with E. faecalis bacteremia, suggesting that echocardiography should be considered in all patients with E. faecalis bacteremia.
Authors: Sandra Chamat-Hedemand; Niels Eske Bruun; Lauge Østergaard; Magnus Arpi; Emil Fosbøl; Jonas Boel; Louise Bruun Oestergaard; Trine K Lauridsen; Gunnar Gislason; Christian Torp-Pedersen; Anders Dahl Journal: BMC Infect Dis Date: 2021-07-16 Impact factor: 3.090