Clinical research study
Enterococcal endocarditis: 107 cases from the international collaboration on endocarditis merged database

https://doi.org/10.1016/j.amjmed.2005.02.020Get rights and content

Abstract

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.

Section snippets

Database

The creation of the International Collaboration on Endocarditis Merged Database has been previously described.21 Briefly, participating members of the International Collaboration on Endocarditis from 7 sites from 5 countries, including the United States (Philadelphia, PA and Durham, NC), United Kingdom (London), France (Marseille and Besancon), Sweden (Gothenburg), and Spain (Barcelona), submitted databases to the coordinating center, the Duke Clinical Research Institute, for inclusion in the

Results

The International Collaboration on Endocarditis Merged Database contains the records of 2212 patients with definite infective endocarditis. One thousand two hundred and eighty-five patients had left-sided native valve endocarditis, including 107 patients due to enterococci, 314 patients due to S. aureus, and 666 patients due to streptococci (Figure 1). The 107 enterococcal strains were distributed as follows: Enterococcus faecalis (n = 62, 58%), Enterococcus faecium (n = 4, 3%), Enterococcus

Discussion

This study includes 107 patients with enterococcal native valve endocarditis. The patients are diverse, coming from 7 centers in the United States and Europe. The breadth of the database allowed us to contrast patients with enterococcal endocarditis with meaningful comparison groups, including patients with endocarditis due to S. aureus and streptococci. This study provides an opportunity to examine and refine previous thoughts about enterococcal endocarditis.

Enterococcal endocarditis was

Acknowledgments

This study was supported in part by the following: National Institutes of Health grants K23 AI-01647 (VGF) and K23 HL70861-01 (CHC), AHA BGIA 0265405U (CHC), the Tenet Healthcare Foundation (Santa Barbara, CA)(EA), the Red Española de Investigación en Patología Infecciosa (V-2003-REDC14A-O)(JMM), the Fundación Privada Máximo Soriano Jiménez (Barcelona, Spain)(JMM), the Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS, Barcelona Spain) (JMM).

From the International Collaboration

References (34)

  • D.M. Shlaes et al.

    Enterococcal bacteremia without endocarditis

    Arch Intern Med.

    (1981)
  • C.H. Cabell et al.

    Changing patient characteristics and the effect on mortality in endocarditis

    Arch Intern Med.

    (2002)
  • G.J. Garvey et al.

    Infective endocarditis-an evolving disease. a review of endocarditis at the Columbia-Presbyterian Medical Center, 1968–1973

    Medicine (Baltimore)

    (1978)
  • J.E. Geraci et al.

    Antibiotic therapy of bacterial endocarditis. VI. subacute enterococcal endocarditis: clinical, pathologic, and therapeutic considerations of 33 cases

    Circulation

    (1954)
  • E. Jawetz et al.

    Penicillin-streptomycin treatment of enterococcal endocarditisA re-evaluation

    N Eng J Med.

    (1966)
  • P.I. Lerner et al.

    Infective endocarditis in the antibiotic era

    N Eng J Med.

    (1966)
  • L. Olaison et al.

    Enterococcal endocarditis in Sweden, 1995–1999can shorter therapy with aminoglycosides be used?

    Clin Infect Dis.

    (2002)
  • Cited by (0)

    No authors have any conflict of interest to disclose regarding the work presented in this manuscript.

    View full text