Prevalence of colorectal cancer in patients with Enterococcus faecalis blood stream infection: A nationwide study

BACKGROUND: Some studies have suggested an association between Enterococcus faecalis blood stream infection (BSI) and colorectal cancer (CRC) suggesting that screening for CRC could be reasonable. However, these studies were limited by small numbers with low generalizability.

METHODS: Danish nationwide registries were used to identify patients with first-time E. faecalis BSI from 2010 to 2021 without previous colorectal neoplasia (CRN). Age-, sex- and calendar-matched comparators from the general population were identified (1:5). We estimated the six-month cumulative incidence of CRC and CRN and a multivariable adjusted Cox analysis was used for relative comparison between groups.

RESULTS: We identified 4664 patients with E. faecalis BSI (median age: 74.9 years, 73.4% males) and 23,320 comparators from the general population. For patients with E. faecalis BSI the six-month incidence of CRC was 0.45% (95% CI: 0.28-0.72%) and of CRN 2.34% (95% CI: 1.88-2.88). For matched comparators the incidence of CRC was 0.12% (95% CI: 0.08-0.17) and of CRN 0.48% (95% CI: 0.39-0.57). In adjusted analysis, patients with E. faecalis BSI had a higher HR of CRC (HR=3.70 (95% CI: 1.91-7.19) and CRN (HR=4.64 (95% CI: 3.40-6.34) than matched comparators. The six-month mortality was 36.3% in patients with E. faecalis BSI while this was 1.7% among comparators.

CONCLUSION: In patients with first-time E. faecalis BSI the six months incidence of CRC was around 0.5% and 2.3% for the diagnosis of CRN, which were 3-4 times higher than in a matched cohort from the general population. Nevertheless, the absolute risks do not justify systematic screening for CRC or CRN in patients with E. faecalis BSI.