Beta-Hemolytic Streptococcal Infective Endocarditis: Characteristics and Outcomes From a Large, Multinational Cohort. (10th April 2020)

• Record Type: Journal Article
• Authors: Fernández Hidalgo, Núria; Gharamti, Amal A; Aznar, María Luisa; Almirante, Benito; Yasmin, Mohamad; Fortes, Claudio Querido; Plesiat, Patrick; Doco-Lecompte, Thanh; Rizk, Hussein; Wray, Dannah; Lamas, Cristiane; Durante-Mangoni, Emanuele; Tattevin, Pierre; Snygg-Martin, Ulrika; Hannan, Margaret M; Chu, Vivian H; Kanafani, Zeina A
• Is Part Of: Open forum infectious diseases. Volume 7:Number 5(2020)
• Publication Date: 2020-04-10
• Subjects: beta-hemolytic streptococci -- cardiac devices -- congestive heart failure -- infective endocarditis -- International Collaboration on Endocarditis; Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofaa120
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: Beta-hemolytic streptococci (BHS) are an uncommon cause of infective endocarditis (IE). The aim of this study was to describe the clinical features and outcomes of patients with BHS IE in a large multinational cohort and compare them with patients with viridans streptococcal IE. Methods: The International Collaboration on Endocarditis Prospective Cohort Study (ICE-PCS) is a large multinational database that recruited patients with IE prospectively using a standardized data set. Sixty-four sites in 28 countries reported patients prospectively using a standard case report form developed by ICE collaborators. Results: Among 1336 definite cases of streptococcal IE, 823 were caused by VGS and 147 by BHS. Patients with BHS IE had a lower prevalence of native valve ( P < .005) and congenital heart disease predisposition ( P = .002), but higher prevalence of implantable cardiac device predisposition ( P < .005). Clinically, they were more likely to present acutely ( P < .005) and with fever ( P = .024). BHS IE was more likely to be complicated by stroke and other systemic emboli ( P < .005). The overall in-hospital mortality of BHS IE was significantly higher than that of VGS IE ( P = .001). In univariate analysis, variables associated with in-hospital mortality for BHS IE were age (odds ratio [OR], 1.044; P = .004), prosthetic valve IE (OR, 3.029; P = .022), congestive heart failure (OR, 2.513; P = .034), and stroke (OR, 3.198; P = .009). Conclusions: BHS IE is characterized by an acute presentation and higher rate of stroke, systemic emboli, and in-hospital mortality than VGS IE. Implantable cardiac devices as a predisposing factor were more often found in BHS IE compared with VGS IE.