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.

Details

Title
Beta-Hemolytic Streptococcal Infective Endocarditis: Characteristics and Outcomes From a Large, Multinational Cohort
Author
Núria Fernández Hidalgo 1 ; Gharamti, Amal A 2 ; Aznar, María Luisa 1 ; Almirante, Benito 1 ; Mohamad Yasmin 3 ; Claudio Querido Fortes 4 ; Plesiat, Patrick 5 ; Doco-Lecompte, Thanh 6 ; Rizk, Hussein 7 ; Wray, Dannah 8 ; Lamas, Cristiane 9 ; Durante-Mangoni, Emanuele 10 ; Tattevin, Pierre 11 ; Snygg-Martin, Ulrika 12 ; Hannan, Margaret M 13 ; Chu, Vivian H 14 ; Kanafani, Zeina A 2 

 Hospital Universitari Vall d’Hebron, Barcelona, Spain 
 American University of Beirut Medical Center, Beirut, Lebanon 
 Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, USA 
 Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil 
 Université de Bourgogne-Franche Comté, Besançon, France 
 University Hospital Geneva, Geneva, Switzerland 
 Cairo University, Cairo, Egypt 
 Medical University of South Carolina, Charleston, South Carolina, USA 
 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 
Publication year
2020
Publication date
May 2020
Publisher
Oxford University Press
e-ISSN
23288957
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
3170976464
Copyright
© The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America. This work is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.