Prevalence, Predictors, Echocardiographic Features, and Clinical Outcomes of Infective Endocarditis in Patients with Streptococcus agalactiae Septicemia

Abstract

Background: Streptococcus agalactiae or Group B Streptococcus (GBS) infective endocarditis (IE) is less common but associated with serious morbidity and mortality. Evidence regarding the prevalence of GBS IE in patients with GBS septicemia is scant. There is also no recommendation for the use of echocardiography in patients with GBS septicemia in the current guidelines. Objective: The primary objective was to determine the prevalence of GBS IE in patients with GBS septicemia. The secondary objective was to assess the predictors, echocardiographic features, and clinical outcomes, including in-hospital mortality, and valvular surgery in patients with GBS IE. Materials and Methods: Consecutive patients older than 18 admitted to Siriraj Hospital due to GBS septicemia between 2005 and 2019 were enrolled. The patients’ characteristics, echocardiographic index reports, and clinical outcomes were reviewed. Univariable and multivariable analyses were performed to determine the predictors of GBS IE. Clinical outcomes of patients with and without GBS IE were compared. A p-value of less than 0.05 was considered statistically significant. Results: Two hundred seven patients were included in the present study. The prevalence of GBS IE was 10.6% (95% CI 6.8 to 15.6). Age, new murmur, and stroke/systemic embolism (SE) were independent predictors for IE in the patients with GBS septicemia. GBS IE caused a sizable proportion of intracardiac complications (36.4%) and moderate-severe valvular regurgitation (68.2%). There was a significant higher rate of in-hospital mortality and valvular surgery in the IE group than in the non-IE group at 63.3% versus 14.1% (p<0.001). Conclusion: There was a sizable proportion of GBS IE in patients admitted due to GBS septicemia. Younger age, new murmur, and stroke/SE were independent predictors of IE in patients with GBS septicemia. Echocardiography should be performed in patients with these predictors to find the evidence and intracardiac complications of GBS IE. Keywords: Echocardiography; Group B Streptococcus; Infective endocarditis; Septicemia; Valvular heart disease