A Contemporary Picture of Enterococcal Endocarditis

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:75

Article

Pericas, Juan M.^1,2  Llopis, Jaume^1,3  Munoz, Patricia⁴  Galvez-Acebal, Juan⁵  Kestler, Martha⁴  Valerio, Maricela⁴  Hernandez-Meneses, Marta¹  Goenaga, Miguel A.⁶  Cobo-Belaustegui, Manuel⁷  Montejo, Miguel⁸  Ojeda-Burgos, Guillermo⁹  Dolores Sousa-Regueiro, M.¹⁰  de Alarcon, Aristides¹¹  Ramos-Martinez, Antonio¹²  Miro, Jose M.¹ 

[1] Univ Barcelona, IDIBAPS, Hosp Clin Barcelona, Barcelona, Spain

[2] Univ Lleida, IRBLleida, Clin Direct Infect Dis & Microbiol, Lleida, Spain

[3] Univ Barcelona, Dept Genet Microbiol & Stat, Barcelona, Spain

[4] Univ Complutense Madrid, CIBER Enfermedades Resp CIBERES CB06 06 0058, Hosp Gen Univ Gregorio Maranon, Inst Invest Sanitaria Gregorio Maranon,Fac Med, Madrid, Spain

[5] Univ Seville, Dept Med, Hosp Univ Virgen Macarena, CSIC,Inst Biomed Sevilla IBiS, Seville, Spain

[6] Hosp Univ Donostia, Donostia San Sebastian, Spain

[7] Hosp Univ Marques de Valdecilla, Santander, Spain

[8] Hosp Univ Cruces, Baracaldo, Spain

[9] Hosp Univ Virgen Victoria, Clin Unit Infect Dis Microbiol & Prevent Med, Malaga, Spain

[10] Complejo Hosp A Coruna, Serv Enfermedades Infecciosas, La Coruna, Spain

[11] Univ Seville, Univ Hosp Virgen Rocio, Clin Unit Infect Dis Microbiol & Prevent Med, CSIC,Inst Biomed Seville IBiS,Infect Dis Res Grp, Seville, Spain

[12] Hosp Univ Puerta Hierro, IDIPHIM, Majadahonda, Spain

关键词: enterococci;    epidemiology;    heart failure;    infective endocarditis;    prosthetic valves;    relapses;   

DOI  :  10.1016/j.jacc.2019.11.047

来源: Elsevier

【 摘 要 】

BACKGROUND Enterococcal endocarditis (EE) is a growing entity in Western countries. However, quality data from large studies is lacking. OBJECTIVES The purpose of this study was to describe the characteristics and analyze the prognostic factors of EE in the GAMES cohort. METHODS This was a post hoc analysis of a prospectively collected cohort of patients from 35 Spanish centers from 2008 to 2016. Characteristics and outcomes of 516 cases of EE were compared with those of 3,308 cases of nonenterococcal endocarditis (NEE). Logistic regression and Cox proportional hazards regression analysis were performed to investigate risk factors for in-hospital and 1-year mortality, as well as relapses. RESULTS Patients with EE were significantly older; more frequently presented chronic lung disease, chronic heart failure, prior endocarditis, and degenerative valve disease; and had higher median age-adjusted Charlson score. EE more frequently involved the aortic valve and prosthesis (64.3% vs. 46.7%; p < 0.001; and 35.9% vs. 28.9%; p = 0.002, respectively) but less frequently pacemakers/defibrillators (1.5% vs. 10.5%; p < 0.001), and showed higher rates of acute heart failure (45% vs. 38.3%; p = 0.005). Cardiac surgery was less frequently performed in EE (40.7% vs. 45.9%; p = 0.024). No differences in in-hospital and 1-year mortality were found, whereas relapses were significantly higher in EE (3.5% vs. 1.7%; p = 0.035). Increasing Charlson score, LogEuroSCORE, acute heart failure, septic shock, and paravalvular complications were risk factors for mortality, whereas prior endocarditis was protective and persistent bacteremia constituted the sole risk factor for relapse. CONCLUSIONS Besides other baseline and clinical differences, EE more frequently affects prosthetic valves and less frequently pacemakers/defibrillators. EE presents higher rates of relapse than NEE. (C) 2020 by the American College of Cardiology Foundation.

【 授权许可】

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