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. 2020 Apr 10;7(5):ofaa120.
doi: 10.1093/ofid/ofaa120. eCollection 2020 May.

Beta-Hemolytic Streptococcal Infective Endocarditis: Characteristics and Outcomes From a Large, Multinational Cohort

Núria Fernández Hidalgo  1 , Amal A Gharamti  2 , María Luisa Aznar  1 , Benito Almirante  1 , Mohamad Yasmin  3 , Claudio Querido Fortes  4 , Patrick Plesiat  5 , Thanh Doco-Lecompte  6 , Hussein Rizk  7 , Dannah Wray  8 , Cristiane Lamas  9 , Emanuele Durante-Mangoni  10 , Pierre Tattevin  11 , Ulrika Snygg-Martin  12 , Margaret M Hannan  13 , Vivian H Chu  14 , Zeina A Kanafani  2
Affiliations

Beta-Hemolytic Streptococcal Infective Endocarditis: Characteristics and Outcomes From a Large, Multinational Cohort

Núria Fernández Hidalgo et al. Open Forum Infect Dis. .

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.

Keywords: International Collaboration on Endocarditis; beta-hemolytic streptococci; cardiac devices; congestive heart failure; infective endocarditis.

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Figures

Figure 1.
Figure 1.
Distribution of streptococcal IE episodes. Abbreviations: BHS, beta-hemolytic streptococci; IE, infective endocarditis; VGS, viridans streptococci.
See this image and copyright information in PMC

References

    1. McCartney AC. Changing trends in infective endocarditis. J Clin Pathol 1992; 45:945–8. - PMC - PubMed
    1. Skinner S, Wudel B, Sanche SE.. Microbiology of infective endocarditis and microbiologic diagnosis. In: Chan KL, Embil J, eds. Endocarditis. Cham, Switzerland: Springer; 2016:49–65.
    1. Kim SL, Gordon SM, Shrestha NK. Distribution of streptococcal groups causing infective endocarditis: a descriptive study. Diagn Microbiol Infect Dis 2018; 91:269–72. - PubMed
    1. Farley MM. Group B streptococcal disease in nonpregnant adults. Clin Infect Dis 2001; 33:556–61. - PubMed
    1. Sambola A, Miro J, Tornos M, et al. . Streptococcus agalactiae infective endocarditis: analysis of 30 cases and review of the literature, 1962–1998. Clin Infect Dis 2002; 34:1576–84. - PubMed