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Abstract
Background
Beta-hemolytic streptococci (BHS) are an uncommon cause of infective endocarditis (IE). The aim of this study was to describe the clinical features and outcomes of patients with BHS IE in a large multinational cohort and compare them with patients with viridans streptococcal IE.
Methods
The International Collaboration on Endocarditis Prospective Cohort Study (ICE-PCS) is a large multinational database that recruited patients with IE prospectively using a standardized data set. Sixty-four sites in 28 countries reported patients prospectively using a standard case report form developed by ICE collaborators.
Results
Among 1336 definite cases of streptococcal IE, 823 were caused by VGS and 147 by BHS. Patients with BHS IE had a lower prevalence of native valve (P < .005) and congenital heart disease predisposition (P = .002), but higher prevalence of implantable cardiac device predisposition (P < .005). Clinically, they were more likely to present acutely (P < .005) and with fever (P = .024). BHS IE was more likely to be complicated by stroke and other systemic emboli (P < .005). The overall in-hospital mortality of BHS IE was significantly higher than that of VGS IE (P = .001). In univariate analysis, variables associated with in-hospital mortality for BHS IE were age (odds ratio [OR], 1.044; P = .004), prosthetic valve IE (OR, 3.029; P = .022), congestive heart failure (OR, 2.513; P = .034), and stroke (OR, 3.198; P = .009).
Conclusions
BHS IE is characterized by an acute presentation and higher rate of stroke, systemic emboli, and in-hospital mortality than VGS IE. Implantable cardiac devices as a predisposing factor were more often found in BHS IE compared with VGS IE.
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Details
1 Hospital Universitari Vall d’Hebron, Barcelona, Spain
2 American University of Beirut Medical Center, Beirut, Lebanon
3 Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, USA
4 Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
5 Université de Bourgogne-Franche Comté, Besançon, France
6 University Hospital Geneva, Geneva, Switzerland
7 Cairo University, Cairo, Egypt
8 Medical University of South Carolina, Charleston, South Carolina, USA
9 Instituto Nacional de Cardiologia and Unigranrio, Rio de Janeiro, Brazil
10 University of Campania, Naples, Italy
11 Université de Rennes, Rennes, France
12 University of Gothenburg, Gothenburg, Sweden
13 Mater Misericordiae University Hospital, Dublin, Ireland
14 Duke University Medical Center, Durham, North Carolina, USA