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Streptococcal infective endocarditis: clinical features and outcomes according to species

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Abstract

Purpose

Infective endocarditis (IE) is frequently caused by streptococcal species, yet clinical features and mortality are poorly investigated. Our aim was to examine patients with streptococcal IE to describe clinical features and outcomes according to streptococcal species.

Methods

From 2002 to 2012, we investigated patients with IE admitted to two tertiary Danish heart centres. Adult patients with left-sided streptococcal IE were included. Adjusted multivariable logistic regression analyses were performed, to assess the association between streptococcal species and heart valve surgery or 1-year mortality.

Results

Among 915 patients with IE, 284 (31%) patients with streptococcal IE were included [mean age 63.5 years (SD 14.1), 69% men]. The most frequent species were S. mitis/oralis (21%) and S. gallolyticus (17%). Fever (86%) and heart murmur (81%) were common symptoms, while dyspnoea was observed in 46%. Further, 18% of all cases were complicated by a cardiac abscess/pseudoaneurysm and 25% by an embolic event. Heart valve surgery during admission was performed in 55% of all patients, and S. gallolyticus (OR 0.28 [95% CI 0.11–0.69]) was associated with less surgery compared with S. mitis/oralis. In-hospital mortality was 7% and 1-year mortality 15%, without any difference between species.

Conclusion

S. mitis/oralis and S. gallolyticus were the most frequent streptococcal species causing IE. Further, S. gallolyticus IE was associated with less heart valve surgery during admission compared with S. mitis/oralis IE. Being aware of specific symptoms, clinical findings, and complications related to different streptococcal species, may help the clinicians in expecting different outcomes.

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Availability of data and materials

All supportive data are available within the article and its supplementary files.

Abbreviations

ANHS:

α- Or non-haemolytic streptococci

BHS:

β-Haemolytic streptococci

CI:

Confidence interval

CIED:

Cardiac implantable electronic device

CRP:

C-reactive protein

DM:

Diabetes mellitus

IE:

Infective endocarditis

IQR:

Interquartile range

MALDI-TOF MS:

Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry

NS:

Non-significant

OR:

Odds ratio

SD:

Standard deviation

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Funding

This work was supported by unrestricted research grants from the Research Council and the Department of Cardiology at Herlev-Gentofte University Hospital; the Department of Cardiology at Zealand University Hospital Roskilde; Direktør Jacob Madsen’s og Hustru Olga Madsen’s fond; Helsefonden (Grant number 20-B-0340); and Skibsreder Per Henriksen, R. og Hustrus Fond. The funders of the study were not involved in the study design, data collection, data analysis, data interpretation, writing of the report or in the decision to submit the paper for publication.

Author information

Author notes

  1. Anders Dahl and Niels Eske Bruun shared joint senior authorship for this article.

Authors and Affiliations

  1. Department of Cardiology, Zealand University Hospital, Sygehusvej 10, 4000, Roskilde, Denmark

    Sandra Chamat-Hedemand & Niels Eske Bruun

  2. Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark

    Sandra Chamat-Hedemand, Anders Dahl, Trine K. Lauridsen, Louise Bruun Oestergaard & Gunnar Gislason

  3. Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen Ø, Denmark

    Christian Hassager, Lauge Østergaard, Henning Bundgaard & Emil Fosbøl

  4. Department of Clinical Microbiology, Copenhagen University Hospital Herlev-Gentofte, Herlev, Denmark

    Magnus Arpi

  5. The Danish Heart Foundation, Copenhagen, Denmark

    Gunnar Gislason

  6. Institute of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark

    Christian Hassager, Henning Bundgaard, Gunnar Gislason & Niels Eske Bruun

  7. Clinical Institute, Aalborg University, Aalborg, Denmark

    Niels Eske Bruun

  8. Department of Cardiology, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark

    Lauge Østergaard

Authors
  1. Sandra Chamat-Hedemand
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Contributions

SCH, AD, and NEB: Design of the project, analysis of data, draft of the manuscript. CH, MA, LØ, HB, TKL, LBO, GG, and EF: Design of the project, critical revision of data, reviewing and editing the manuscript. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Sandra Chamat-Hedemand.

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Conflict of interest

None declared.

Ethics approval and consent to participate

Informed consent from each patient was not necessary, since the study was approved by the Danish Health Authority (Journal No. 3-3013-849/1/) and the Danish Data Protection Agency (Journal No. 2011-41-6485). Since data were collected from patient files, no additional interventions were performed. Therefore, ethics approvals were not necessary. All experiments were performed in accordance with relevant guidelines and regulations. Data were anonymised before analyses were performed. No other administrative permissions were required.

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Supplementary file1 (DOCX 530 KB)

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Chamat-Hedemand, S., Dahl, A., Hassager, C. et al. Streptococcal infective endocarditis: clinical features and outcomes according to species. Infection 51, 869–879 (2023). https://doi.org/10.1007/s15010-022-01929-1

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  • DOI: https://doi.org/10.1007/s15010-022-01929-1

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