Abstract
Knowledge of infective endocarditis (IE) caused by Streptococcus dysgalactiae (SD) is limited. This study aimed to identify the clinical and microbiological features of SD-caused IE and to investigate any possible synergy between penicillin and gentamicin on SD isolates. Cases of IE 2008–2016 due to SD reported to the Swedish Registry of Infective Endocarditis (SRIE) were identified. Isolates were emm typed and synergy between antibiotics was determined in time-kill experiments. Medical records were reviewed and SD-cases were compared to cases of IE due to other pathogens reported to the SRIE. Fifty cases of SD-caused IE were confirmed. emm types stC74a, stG62647, and stG643 were most commonly encountered. The patients had a median age of 74 years (range 38–93) and were significantly older compared to patients with Staphylococcus aureus-caused IE, (65 years (p = 0.003)). The median time to diagnosis from symptom onset was 1 day for patients with SD-caused IE which was less compared to patients with IE due to the other pathogens (2–15 days). Embolization was seen in 46% and the in-hospital mortality was 8%. Etest-based methods did not indicate any synergy between penicillin and gentamicin whereas synergy was noted for four out of nine isolates applying time-kill assays. This is the largest study of SD-caused IE, a condition with an acute onset predominantly affecting elderly people. Synergy between penicillin and gentamicin against some SD isolates was distinguished but the potential benefit of this must be weighed against the risk of aminoglycoside side effects.
Highlights
Microbiology, Lund University, Lund, Sweden 4 Department of Clinical Microbiology, Karolinska UniversityHospital, Huddinge, Stockholm, Sweden 5 Division of Clinical Microbiology, Department of LaboratoryMedicine, Karolinska Institutet, Stockholm, Sweden 6 Department of Infectious Diseases, Sahlgrenska University Hospital, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden 7 Swedish Society of Infectious Diseases, Swedish Registry of Infective Endocarditis, Gothenburg, SwedenDuring the past years, invasive infections due to Streptococcus dysgalactiae (SD) have been increasingly reported worldwide [1]
Several molecular epidemiological studies have investigated the distribution of emm types among SD isolates in attempt to link different emm types to invasive or non-invasive infections [1, 6, 7]
This study aimed to delineate clinical features of SD in infective endocarditis (IE), to describe which emm types are prevalent in the condition and to investigate the antibiotic susceptibility and possible synergistic effect between penicillin and gentamicin on SD isolates from IE
Summary
Microbiology, Lund University, Lund, Sweden 4 Department of Clinical Microbiology, Karolinska University. Huddinge, Stockholm, Sweden 5 Division of Clinical Microbiology, Department of Laboratory. Karolinska Institutet, Stockholm, Sweden 6 Department of Infectious Diseases, Sahlgrenska University Hospital, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden 7 Swedish Society of Infectious Diseases, Swedish Registry of Infective Endocarditis, Gothenburg, Sweden. Invasive infections due to Streptococcus dysgalactiae (SD) have been increasingly reported worldwide [1]. Further typing of SD is based on the sequence of the 5′-part of the emm gene encoding the hypervariable NH2-terminal part of the cell wallattached M protein [4, 5]. SD can cause both superficial and invasive infections often with a focus in soft tissues [8]. A severe type of infection caused by SD is infective endocarditis (IE).
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