Characteristics and regional variations of group D streptococcal endocarditis in France

Abstract

The proportion of infective endocarditis (IE) caused by group D streptococci (GDS; formerly Streptococcus bovis) increased markedly in France, to account for 25% of all cases of IE by 1999. In an attempt to explain this phenomenon, a comparative analysis of GDS and oral streptococci (OS) causing IE was performed. This study was based on data collected from a large cross-sectional population-based survey that was conducted in 1999. In total, 559 cases of definite IE were recorded, of which 142 involved GDS and 79 involved OS. Patients with GDS IE were older (62.7 vs. 56.6 years, p 0.01) and had a history of valve disease less frequently than did patients with OS IE (33.8% vs. 67.1%, p <0.0001). At-risk procedures for IE were performed less frequently in patients with GDS than in patients with OS (14.8% vs. 24.1%, p 0.08), but co-morbidities were more frequent in the GDS group (59.9% vs. 32.9%, p 0.0001). Diabetes, colon diseases and cirrhosis were also more frequent in the GDS group (p 0.006, p <0.0001 and p 0.08, respectively). Rural residents accounted for 31.0% of the GDS group, but for only 15.2% of the OS group (p 0.001). Likewise, the proportion of GDS IE was higher in regions with mixed (urban and rural) populations (Franche-Comté 81.8%, Marne 68.7%, Lorraine 70.3% and Rhône-Alpes 65.3%) than in exclusively urban regions (Paris and Ile de France 58.0%). Further investigations are required to elucidate the link in France between the incidence of GDS IE, rural residency and nutritional factors.

Comprehensive Study of Strains Previously Designated Streptococcus bovis Consecutively Isolated from Human Blood Cultures and Emended Description of Streptococcus gallolyticus and Streptococcus infantarius subsp. coli

“…In our study, more male patients than females with S. bovis blood culture isolates were seen, as already reported in other studies (range, 66 to 82%) (2,6,18). The mean age of the patients in our series was also similar to that of the other studies (range, 59 to 67 years) (2,6,18).…”

“…The mean age of the patients in our series was also similar to that of the other studies (range, 59 to 67 years) (2,6,18). In contrast to most other studies on S. bovis blood culture isolates, we observed significantly fewer cases of endocarditis (29%) and colon carcinomas (7%) in all patients, whereas in the classic study by Ruoff et al, 94% of all bacteremic patients with S. bovis biotype I had endocarditis and 71% had colon carcinoma (13).…”

“…gallolyticus strains. Therefore, studies (2,6) including only Lancefield group D streptococci isolated from blood cultures may have a bias toward S. gallolyticus subsp. gallolyticus and underestimate the number of S. gallolyticus subsp.…”

Streptococcus gallolyticus subsp. gallolyticus from Human and Animal Origins: Genetic Diversity, Antimicrobial Susceptibility, and Characterization of a Vancomycin-Resistant Calf Isolate Carrying a vanA -Tn 1546 -Like Element

“…gallolyticus strains between animals and humans has not been documented yet, although in view of the example of the related genus Enterococcus, zoonotic potential cannot be ruled out. A major prevalence of endocarditis caused by S. bovis in rural areas of France and Spain has been demonstrated in this sense (20,21).We have characterized an S. gallolyticus subsp. gallolyticus collection including isolates recovered from animals and humans and have compared their genetic diversity and antimicrobial susceptibility profiles.…”

“…gallolyticus strains between animals and humans has not been documented yet, although in view of the example of the related genus Enterococcus, zoonotic potential cannot be ruled out. A major prevalence of endocarditis caused by S. bovis in rural areas of France and Spain has been demonstrated in this sense (20,21).…”