Risk for infective endocarditis in bacteremia with Gram positive cocci.

Abstract

Infective endocarditis (IE) is a serious complication of bacteremia and is most often caused by Gram positive cocci. We investigated the prevalence of IE in patients where echocardiography was encouraged when bacteremia with Gram positive cocci was present. The study included patients with Gram positive cocci bacteremia hospitalized at two Danish hospitalsbetweenMarchandDecember 2016. Information concerning echocardiography, demographics and bacterialspecieswas collected from thepatients'medicalfiles. Patients without echocardiography were followed for 6months in order to confirm orrejectpossible IE. The study included 585 patients with Gram positive cocci bacteremia, and echocardiography was performed in 414 (71%) of them. The prevalence of IE in patients with high risk bacteremia, i.e. Staphylococcus aureus, non-beta-hemolytic streptococci, Enterococcus faecalis, and coagulase-negative staphylococci was 16%. Patients with Enterococcus faecalis had the highest prevalence of IE (33%) followed by non-beta-hemolytic streptococci (23%) and Staphylococcus aureus (12%). Among low risk bacteremia the prevalence of IE was 1%. The mean age of patients with IE was 74years (SD 12.9) and 71% were male. These findings strongly support routine echocardiography in patients with high risk bacteremia and non-performance of echocardiography in patients with low risk bacteremia.