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. 2023 Dec;51(6):1739-1747.
doi: 10.1007/s15010-023-02068-x. Epub 2023 Jul 3.

Recurrence of bacteremia and infective endocarditis according to bacterial species of index endocarditis episode

Lauge Østergaard  1 , Marianne Voldstedlund  2 , Niels Eske Bruun  3   4 , Henning Bundgaard  5   6 , Kasper Iversen  7 , Mia Marie Pries-Heje  5   7 , Katra Hadji-Turdeghal  5 , Peter L Graversen  5 , Claus Moser  8   9 , Christian Østergaard Andersen  10 , Kirstine Kobberøe Søgaard  11   12   13 , Lars Køber  5 , Emil Loldrup Fosbøl  5
Affiliations

Recurrence of bacteremia and infective endocarditis according to bacterial species of index endocarditis episode

Lauge Østergaard et al. Infection. 2023 Dec.

Abstract

Purpose: In patients surviving infective endocarditis (IE) recurrence of bacteremia or IE is feared. However, knowledge is sparse on the incidence and risk factors for the recurrence of bacteremia or IE.

Methods: Using Danish nationwide registries (2010-2020), we identified patients with first-time IE which were categorized by bacterial species (Staphylococcus aureus, Enterococcus spp., Streptococcus spp., coagulase-negative staphylococci [CoNS], 'Other' microbiological etiology). Recurrence of bacteremia (including IE episodes) or IE with the same bacterial species was estimated at 12 months and 5 years, considering death as a competing risk. Cox regression models were used to compute adjusted hazard ratios of the recurrence of bacteremia or IE.

Results: We identified 4086 patients with IE; 1374 (33.6%) with S. aureus, 813 (19.9%) with Enterococcus spp., 1366 (33.4%) with Streptococcus spp., 284 (7.0%) with CoNS, and 249 (6.1%) with 'Other'. The overall 12-month incidence of recurrent bacteremia with the same bacterial species was 4.8% and 2.6% with an accompanying IE diagnosis, while this was 7.7% and 4.0%, respectively, with 5 years of follow-up. S. aureus, Enterococcus spp., CoNS, chronic renal failure, and liver disease were associated with an increased rate of recurrent bacteremia or IE with the same bacterial species.

Conclusion: Recurrent bacteremia with the same bacterial species within 12 months, occurred in almost 5% and 2.6% for recurrent IE. S. aureus, Enterococcus spp., and CoNS were associated with recurrent infections with the same bacterial species.

Keywords: Bacteremia; Infective endocarditis; Recurrence; Reinfection; Relapse.

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Conflict of interest statement

Lauge Østergaard: has received an independent research grant from the Novo Nordisk Foundation (NNF23OC0081668) related to mitral valve regurgitation. Marianne Voldstedlund: has received a grant from the Novo Nordisk Foundation (NNF20OC0063177) not related to this work; lecture fee from MyLab Oy, Finland. Niels Eske Bruun: has received investigator-initiated grants from: The Novo Nordisk Foundation, The Augustinus Foundation, The Kaj Hansen Foundation, and Health Insurance Denmark, not related to this study. Henning Bundgaard: has received lecture fees from Bristol Myers Squibb, Sanofi, MSD and Amgen. Kasper Iversen: None. Mia Marie Pries-Heje: None. Katra Hadji -Turdeghal: None. Peter Graversen: None. Claus Moser: Supported by the Novo Nordisk Foundation—“Borregaard Clinical Scientist Grant” (Grant no. NNF17OC0025074). Christian Østergaard Andersen: None. Kirstine Kobberøe Søgaard: None. Lars Køber: Speaker’s honorarium from Novo, Novartis, AstraZeneca, Boehringer and Bayer. Emil Loldrup Fosbøl: Novo Nordisk Foundation and the Danish Heart Association: Independent research grant related to valvular heart disease and endocarditis.

Figures

Fig. 1
Fig. 1
Cumulative incidence of recurrent bacteremia with the same bacterial species of the primary IE. The figure shows the cumulative incidence of a recurrent episode of bacteremia with the same bacterial species causing the primary episode of IE within 12 months of follow-up, panel a (left) and a maximum of 5 years of follow-up, panel b (right)
Fig. 2
Fig. 2
Cumulative incidence of recurrent IE with the same bacterial species. The figure shows the cumulative incidence of a recurrent episode of IE with the same bacterial species within 12 months of follow-up, panel a (left) and a maximum of 5 years of follow-up, panel b (right)
Fig. 3
Fig. 3
Factors associated recurrent bacteremia and IE. The figure shows the associated HR for recurrent bacteremia with the same bacterial species within 12 months (a) and 5 years of follow-up (b). The associated HR for recurrent IE with the same bacterial species with 12 months of follow-up (c) and 5 years of follow-up (d). *Streptococcus spp. as a reference group. CoNS coagulase-negative staphylococci, CIED cardiac implantable electronic device, IE infective endocarditis, HR hazard ratio, LCI lower confidence interval, UCI upper confidence interval
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