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Rigshospitalet - a part of Copenhagen University Hospital
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Prevalence of Infective Endocarditis in Enterococcus faecalis Bacteremia

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  • Anders Dahl
  • Kasper Iversen
  • Niels Tonder
  • Nis Hoest
  • Magnus Arpi
  • Morten Dalsgaard
  • Mahtab Chehri
  • Lars L Soerensen
  • Soren Fanoe
  • Soeren Junge
  • Ulla Hoest
  • Nana Valeur
  • Trine K Lauridsen
  • Emil Fosbol
  • Thomas Hoi-Hansen
  • Niels E Bruun
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Background: Enterococcus faecalis is the third most frequent cause of infective endocarditis (IE). Despite this, no systematic prospective echocardiography studies have examined the prevalence of IE in patients with E. faecalis bacteremia. Objectives: This study sought to determine the prevalence of IE in patients with E. faecalis bacteremia. The secondary objective was to identify predictors of IE. Methods: From January 1, 2014, to December 31, 2016, a prospective multicenter study was conducted with echocardiography in consecutive patients with E. faecalis bacteremia. Predictors of IE were assessed using multivariate logistic regression with backward elimination. Results: A total of 344 patients with E. faecalis bacteremia were included, all examined using echocardiography, including transesophageal echocardiography in 74% of the cases. The patients had a mean age of 74.2 years, and 73.5% were men. Definite endocarditis was diagnosed in 90 patients, resulting in a prevalence of 26.1 ± 4.6% (95% confidence interval [CI]). Risk factors for IE were prosthetic heart valve (odds ratio [OR]: 3.93; 95% CI: 1.76 to 8.77; p = 0.001), community acquisition (OR: 3.35; 95% CI: 1.74 to 6.46; p < 0.001), ≥3 positive blood culture bottles (OR: 3.69; 95% CI: 1.88 to 7.23; p < 0.001), unknown portal of entry (OR: 2.36; 95% CI: 1.26 to 4.40; p = 0.007), monomicrobial bacteremia (OR: 2.73; 95% CI: 1.23 to 6.05; p = 0.013), and immunosuppression (OR: 2.82; 95% CI: 1.20 to 6.58; p = 0.017). Conclusions: This study revealed a high prevalence of 26% definite IE in patients with E. faecalis bacteremia, suggesting that echocardiography should be considered in all patients with E. faecalis bacteremia.

Original languageEnglish
JournalJournal of the American College of Cardiology
Volume74
Issue number2
Pages (from-to)193-201
Number of pages9
ISSN0735-1097
DOIs
Publication statusPublished - 16 Jul 2019

    Research areas

  • blood cultures, community acquisition, echocardiography, prosthetic heart valve, risk factors, screening

ID: 57567197