Streptococcal infective endocarditis: clinical features and outcomes according to species

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Purpose: Infective endocarditis (IE) is frequently caused by streptococcal species, yet clinical features and mortality are poorly investigated. Our aim was to examine patients with streptococcal IE to describe clinical features and outcomes according to streptococcal species. Methods: From 2002 to 2012, we investigated patients with IE admitted to two tertiary Danish heart centres. Adult patients with left-sided streptococcal IE were included. Adjusted multivariable logistic regression analyses were performed, to assess the association between streptococcal species and heart valve surgery or 1-year mortality. Results: Among 915 patients with IE, 284 (31%) patients with streptococcal IE were included [mean age 63.5 years (SD 14.1), 69% men]. The most frequent species were S. mitis/oralis (21%) and S. gallolyticus (17%). Fever (86%) and heart murmur (81%) were common symptoms, while dyspnoea was observed in 46%. Further, 18% of all cases were complicated by a cardiac abscess/pseudoaneurysm and 25% by an embolic event. Heart valve surgery during admission was performed in 55% of all patients, and S. gallolyticus (OR 0.28 [95% CI 0.11–0.69]) was associated with less surgery compared with S. mitis/oralis. In-hospital mortality was 7% and 1-year mortality 15%, without any difference between species. Conclusion: S. mitis/oralis and S. gallolyticus were the most frequent streptococcal species causing IE. Further, S. gallolyticus IE was associated with less heart valve surgery during admission compared with S. mitis/oralis IE. Being aware of specific symptoms, clinical findings, and complications related to different streptococcal species, may help the clinicians in expecting different outcomes.

Original languageEnglish
JournalInfection
Volume51
Issue number4
Pages (from-to)869-879
Number of pages11
ISSN0300-8126
DOIs
Publication statusPublished - 2023

Bibliographical note

Funding Information:
This work was supported by unrestricted research grants from the Research Council and the Department of Cardiology at Herlev-Gentofte University Hospital; the Department of Cardiology at Zealand University Hospital Roskilde; Direktør Jacob Madsen’s og Hustru Olga Madsen’s fond; Helsefonden (Grant number 20-B-0340); and Skibsreder Per Henriksen, R. og Hustrus Fond. The funders of the study were not involved in the study design, data collection, data analysis, data interpretation, writing of the report or in the decision to submit the paper for publication.

    Research areas

  • Infective endocarditis, Mortality, Streptococcal species, Surgery, Symptoms

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