Enterococcal endocarditis: 107 cases from the international collaboration on endocarditis merged database.

PURPOSE To describe clinical features and outcomes of enterococcal left-sided native valve endocarditis and to compare it to endocarditis caused by other pathogens. SUBJECTS AND METHODS Patients in the International Collaboration on Endocarditis-Merged Database were included if they had left-sided native valve endocarditis. Demographic characteristics, clinical features, and outcomes were analyzed. Multivariable analysis evaluated enterococcus as a predictor of mortality. RESULTS Of 1285 patients with left-sided native valve endocarditis, 107 had enterococcal endocarditis. Enterococcal endocarditis was most frequently seen in elderly men, frequently involved the aortic valve, tended to produce heart failure rather than embolic events, and had relatively low short-term mortality. Compared to patients with non-enterococcal endocarditis, patients with enterococcal endocarditis had similar rates of nosocomial acquisition, heart failure, embolization, surgery, and mortality. Compared to patients with streptococcal endocarditis, patients with enterococcal endocarditis were more likely to be nosocomially acquired (9 of 59 [15%] vs 2 of 400 [1%]; P <.0001) and have heart failure (49 of 107 [46%] vs 234 of 666 [35%]; P = 0.03). Compared to patients with S. aureus endocarditis, patients with enterococcal endocarditis were less likely to embolize (28 of 107 [26%] vs 155 of 314 [49%]; P <.0001) and less likely to die (12 of 107 [11%] vs 83 of 313 [27%]; P = 0.001). Multivariable analysis of all patients with left-sided native valve endocarditis showed that enterococcal endocarditis was associated with lower mortality (odds ratio [OR] 0.49; 95% confidence interval [CI] 0.24 to 0.97). CONCLUSIONS Enterococcal native valve endocarditis has a distinctive clinical picture with a good prognosis.

[1]  H. Neu,et al.  INFECTIVE ENDOCARDITIS—AN EVOLVING DISEASE: A Review of Endocarditis at The Columbia‐Presbyterian Medical Center, 1968–1973 , 1978, Medicine.

[2]  S. Eykyn,et al.  Bicuspid aortic valve--A silent danger: analysis of 50 cases of infective endocarditis. , 2000, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[3]  W. J. Martin,et al.  Antibiotic Therapy of Bacterial Endocarditis: IV. Successful Short‐Term (Two Weeks) Combined Penicillin‐Dihydrostreptomycin Therapy in Subacute Bacterial Endocarditis Caused by Penicillin‐Sensitive Streptococci , 1953, Circulation.

[4]  Vance G Fowler,et al.  Changing patient characteristics and the effect on mortality in endocarditis. , 2002, Archives of internal medicine.

[5]  J. Mathew,et al.  Clinical features, site of involvement, bacteriologic findings, and outcome of infective endocarditis in intravenous drug users. , 1995, Archives of internal medicine.

[6]  D Raoult,et al.  Echocardiography predicts embolic events in infective endocarditis. , 2001, Journal of the American College of Cardiology.

[7]  D. Shlaes,et al.  Enterococcal bacteremia without endocarditis. , 1981, Archives of internal medicine.

[8]  C. Cabell,et al.  Progress toward a global understanding of infective endocarditis. Lessons from the International Collaboration on Endocarditis. , 2003, Cardiology clinics.

[9]  D. Durack,et al.  New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. , 1994, The American journal of medicine.

[10]  J. Gatell,et al.  Infective endocarditis not related to intravenous drug abuse in HIV-1-infected patients: report of eight cases and review of the literature. , 2003, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[11]  I. Gadea,et al.  Nosocomial enterococcal endocarditis: a serious hazard for hospitalized patients with enterococcal bacteraemia , 2002, Journal of internal medicine.

[12]  B. Hoen,et al.  The Duke criteria for diagnosing infective endocarditis are specific: analysis of 100 patients with acute fever or fever of unknown origin. , 1996, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[13]  P. Marx,et al.  Endocarditis due to enterococcus faecalis: risk factors and outcome in twenty-one cases from a five year national survey. , 1998, Scandinavian journal of infectious diseases.

[14]  N. Reiner,et al.  Enterococcal endocarditis in heroin addicts. , 1976, JAMA.

[15]  C. Cabell,et al.  Progress toward a global understanding of infective endocarditis. Early lessons from the International Collaboration on Endocarditis investigation. , 2002, Infectious disease clinics of North America.

[16]  R G Petersdorf,et al.  INFECTIVE ENDOCARDITIS: A REVIEW OF 125 CASES FROM THE UNIVERSITY OF WASHINGTON HOSPITALS, 1963–72 , 1977, Medicine.

[17]  L. Weinstein,et al.  Infective endocarditis in the antibiotic era. , 1966, The New England journal of medicine.

[18]  L. Melton,et al.  Influence of referral bias on the apparent clinical spectrum of infective endocarditis. , 1990, The American journal of medicine.

[19]  D. Murdoch,et al.  Risk Factors for Infective Endocarditis in Patients with Enterococcal Bacteremia: A Case-Control Study , 2004, Infection.

[20]  R. Moellering,et al.  Endocarditis due to group D streptococci. Comparison of disease caused by streptococcus bovis with that produced by the enterococci. , 1974, The American journal of medicine.

[21]  E Abrutyn,et al.  Incidence of infective endocarditis in the Delaware Valley, 1988-1990. , 1995, The American journal of cardiology.

[22]  E. Hook,et al.  Enterococcal endocarditis. An analysis of 38 patients observed at the New York Hospital-Cornell Medical Center. , 1970, Archives of internal medicine.

[23]  J. Mills,et al.  Heart failure in infective endocarditis: predisposing factors, course, and treatment. , 1974, Chest.

[24]  W. Woodward,et al.  Analysis of surgical versus medical therapy in active complicated native valve infective endocarditis. , 1983, The American journal of cardiology.

[25]  M. Terpenning,et al.  Infective endocarditis: clinical features in young and elderly patients. , 1987, The American journal of medicine.

[26]  J. Ryan,et al.  Optimal therapy for enterococcal endocarditis. , 1984, The American journal of medicine.

[27]  D. Maki,et al.  Enterococcal Bacteremia: Clinical Features, the Risk of Endocarditis, and Management , 1988, Medicine.

[28]  E. Jawetz,et al.  Penicillin-streptomycin treatment of enterococcal endocarditis. A re-evaluation. , 1966, The New England journal of medicine.

[29]  L. Rice,et al.  Enterococcal endocarditis: a comparison of prosthetic and native valve disease. , 1991, Reviews of infectious diseases.

[30]  C. Watanakunakorn,et al.  Enterococcal bacteremia in two large community teaching hospitals. , 1986, The American journal of medicine.

[31]  M. Sande,et al.  Treatment of streptomycin-susceptible and streptomycin-resistant enterococcal endocarditis. , 1984, Annals of internal medicine.

[32]  L. Olaison,et al.  Enterococcal endocarditis in Sweden, 1995-1999: can shorter therapy with aminoglycosides be used? , 2002, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[33]  W. J. Martin,et al.  Antibiotic Therapy of Bacterial Endocarditis: VI. Subacute Enterococcal Endocarditis Clinical, Pathologic and Therapeutic Consideration of 33 Cases , 1954, Circulation.

[34]  D. Kaye,et al.  Enterococcal endocarditis. Report of nineteen cases with long-term follow-up data. , 1961, The New England journal of medicine.