Infective endocarditis common in patients with E. faecalis bacteremia
Among a cohort of patients with Enterococcus faecalis bacteremia who underwent echocardiography, more than one-quarter had infective endocarditis, according to data published in the Journal of the American College of Cardiology.
The researchers conducted a prospective multicenter study of 344 patients (mean age, 74 years; 74% men) with E. faecalis to determine the prevalence of infective endocarditis and to identify predictors of it. All patients underwent echocardiography and 74% had transesophageal echocardiography.
Among the cohort, 90 patients had definite infective endocarditis, for a prevalence of 26.1%, Anders Dahl, MD, PhD, cardiologist at Herlev Gentofte University Hospital and Bispebjerg Hospital in Copenhagen, Denmark, and colleagues wrote.
Independent predictors of infective endocarditis included a prosthetic heart valve (OR = 3.93; 95% CI, 1.76-8.77), community acquisition of E. faecalis (OR = 3.35; 95% CI, 1.74-6.46), at least three positive blood culture bottles (OR = 3.69; 95% CI, 1.88-7.23), unknown portal of entry (OR = 2.36; 95% CI, 1.26-4.4), monomicrobial bacteremia (OR = 2.73; 95% CI, 1.23-6.05) and immunosuppression (OR = 2.82; 95% CI, 1.2-6.58), according to the researchers.
“It seems that the more extensively we examine using echocardiography, the higher the detection rate of [infective endocarditis],” Dahl and colleagues wrote. “This is not surprising, but the question is, do we overlook cases of [infective endocarditis] in the normal clinical routine? The discrepancy in [infective endocarditis] prevalence between our prospective study and the previous studies suggests a substantial underdiagnosis of E. faecalis endocarditis in the general everyday clinic represented by the earlier studies.”
In a related editorial, Nuria Fernández-Hidalgo, MD, PhD, from Servei de Malalties Infeccioses, Hospital Universitari Vall d’Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain, and Laura Escolà-Vergé, MD, from the Spanish Network for Research in Infectious Diseases (REIPI), Madrid, wrote that in regard to use of echocardiography, “we agree that it is better to overtreat than to fail to treat.”
Because the rates of infective endocarditis were only 3% in patients with no risk factors and 14% in patients with one or two risk factors, “similar to what occurs in Staphylococcus aureus bacteremia (in which the risk of [infective endocarditis] is elevated), an echocardiogram might not be recommended for all patients, and the decision to perform an echocardiogram should be individualized on a case-by-case basis,” they wrote. – by Erik Swain
Disclosures: The authors and editorial writers report no relevant financial disclosures.