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Infective Endocarditis in Patients With Positive Blood Cultures
Study Questions:
How prevalent is infective endocarditis (IE) among patients with a blood stream infection typically associated with IE?
Methods:
The Danish National Patient Registry, the Danish Prescription Registry, and the Danish Microbiological Database were used to identify patients from 2010-2017 with a blood stream infection typically associated with IE: Enterococcus faecalis (E. faecalis), Staphylococcus aureus (S. aureus), Streptococcus species, and coagulase negative staphylococci (CoNS), and examine the concurrent prevalence of IE. A trend test was used to examine temporal changes in the prevalence of IE.
Results:
A total of 69,021 blood stream infections were identified during the study period, with 15,350 during 2010-2011, 16,726 during 2012-2013, 19,251 during 2014-2015, and 17,694 during 2016-2017. Patients with E. faecalis blood stream infection had the highest prevalence of IE (16.7%) followed by S. aureus (10.1%), Streptococcus species (7.3%), and CoNS (1.6%). Throughout the study period, the prevalence of IE among patients with E. faecalis and Streptococcus species increased significantly (p = 0.0005 and p = 0.03, respectively). For E. faecalis, Streptococcus species, and CoNS blood stream infections, male patients had a higher prevalence of IE compared with female patients. A significant increase in the prevalence of IE with increasing patient age was seen for E. faecalis, Streptococcus species, and CoNS.
Conclusions:
Among patients with a blood stream infection with E. faecalis, 1 in 6 had IE; for S. aureus, 1 in 10 patients had IE, and for Streptococcus species, 1 in 14 had IE. The authors concluded that these results support screening for IE among patients with a blood stream infection with E. faecalis, S. aureus, or Streptococcus species.
Perspective:
Although based on data from administrative databases, this study helps define the prevalence of IE among patients with a blood stream infection with various micro-organisms. Male patients and older patients had higher rates of IE associated with E. faecalis, Streptococcus species, and coagulase-negative staphylococci blood stream infections. These data might help guide strategies to screen patients with a blood stream infection for clinical IE.
Keywords: Bacteremia, Coagulase, Endocarditis, Endocarditis, Bacterial, Enterococcus, Enterococcus faecalis, Heart Valve Diseases, Primary Prevention, Staphylococcal Infections, Staphylococcus, Staphylococcus aureus, Streptococcus
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