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A Contemporary Picture of Enterococcal Endocarditis
Study Questions:
What are the characteristics of and prognostic factors associated with enterococcal endocarditis (EE)?
Methods:
The Spanish Collaboration on Endocarditis (Grupo de Apoyo al Manejo de la Endocarditis Infecciosa en España [GAMES cohort]) is a multicenter prospective observational study that includes patients from 35 Spanish centers between 2008 and 2016. Using these data, a post hoc analysis was performed evaluating the characteristics and outcomes of 516 cases of EE compared to 3,308 cases of non-EE (NEE). Logistic regression and Cox proportional hazards regression analyses were performed to investigate risk factors for in-hospital and 1-year mortality, and endocarditis relapses.
Results:
Patients with EE were significantly older; more frequently presented with chronic lung disease, chronic heart failure, prior endocarditis, and degenerative valve disease; and had higher median age-adjusted Charlson score. EE more frequently involved the aortic valve (64.3% vs. 46.7%, p < 0.001) and a prosthetic valve (35.9% vs. 28.9%, p = 0.002), but less frequently pacemakers/defibrillators (1.5% vs. 10.5%, p < 0.001); and was associated with higher rates of acute heart failure (45% vs. 38.3%, p = 0.005). Cardiac surgery was less frequently performed in EE (40.7% vs. 45.9%, p = 0.024). No differences in in-hospital and 1-year mortality were found, whereas relapses were significantly higher in EE (3.5% vs. 1.7%, p = 0.035). Increasing Charlson score, LogEuroSCORE, acute heart failure, septic shock, and paravalvular complications were risk factors for mortality; whereas prior endocarditis was associated with lower mortality, and persistent bacteremia was the sole risk factor for endocarditis relapse.
Conclusions:
There were differences in clinical characteristics between patients with EE and those with NEE. In addition, EE more frequently affected prosthetic valves and less frequently pacemakers/defibrillators, and was associated with a higher rate of relapse compared to NEE.
Perspective:
EE is a growing health problem that has transitioned from a predominantly community-acquired, indolent disease with a genitourinary source to a more aggressive healthcare-associated disease often without a clearly identifiable source. This post hoc analysis of prospectively collected data from multiple Spanish centers found patients with EE compared to NEE tended to be older, with underlying lung disease, chronic heart failure, prior endocarditis, and a higher index of comorbidities; and that EE more frequently affected prosthetic valves and less frequently pacemakers/defibrillators, and was associated with a higher rate of relapse compared to NEE. These findings underscore the evolving nature of infective endocarditis in general, and of EE in particular.
Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Valvular Heart Disease, Implantable Devices, SCD/Ventricular Arrhythmias, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Acute Heart Failure, Interventions and Imaging, Interventions and Structural Heart Disease
Keywords: Bacteremia, Cardiac Surgical Procedures, Defibrillators, Implantable, Diagnostic Imaging, Endocarditis, Endocarditis, Bacterial, Heart Failure, Heart Valve Diseases, Heart Valve Prosthesis, Lung Diseases, Pacemaker, Artificial, Risk Factors, Shock, Septic
