Prevalence of infective endocarditis in patients with positive blood cultures: a Danish nationwide study

Abstract

Aims Increasing attention has been given to the risk of infective endocarditis (IE) in patients with certain blood stream infections (BSIs). Previous studies have been conducted on selected patient cohorts, yet unselected data are sparse. We aimed to investigate the prevalence of IE in BSIs with bacteria typically associated with IE. Methods and results By crosslinking nationwide registries from 2010 to 2017, we identified patients with BSIs typically associated with IE: Enterococcus faecalis (E. faecalis), Staphylococcus aureus (S. aureus), Streptococcus spp., and coagulase negative staphylococci (CoNS) and examined the concurrent IE prevalence. A trend test was used to examine temporal changes in the prevalence of IE. In total 69 021, distributed with 15 350, 16 726, 19 251, and 17 694 BSIs were identified in the periods of 2010–2011, 2012–2013, 2014–2015, and 2016–2017, respectively. Patients with E. faecalis had the highest prevalence of IE (16.7%) followed by S. aureus (10.1%), Streptococcus spp. (7.3%), and CoNS (1.6%). Throughout the study period, the prevalence of IE among patients with E. faecalis and Streptococcus spp. increased significantly (P = 0.0005 and P = 0.03, respectively). Male patients had a higher prevalence of IE for E. faecalis, Streptococcus spp., and CoNS compared with females. A significant increase in the prevalence of IE was seen for E. faecalis, Streptococcus spp., and CoNS with increasing age. Conclusion For E. faecalis BSI, 1 in 6 had IE, for S. aureus BSI 1 in 10 had IE, and for Streptococcus spp. 1 in 14 had IE. Our results suggest that screening for IE seems reasonable in patients with E. faecalis BSI, S. aureus BSI, or Streptococcus spp. BSI.

Short time to blood culture positivity in Enterococcus faecalis infective endocarditis

“…In order to avoid unnecessary investigations, recent work has focused on identifying risk factors of IE in EFsB. These studies have collectively demonstrated a relatively high risk for IE in patients with monomicrobial EFsB [15][16][17] and have suggested unknown focus of primary infection and several positive blood cultures as risk factors for IE in enterococcal bacteremia [17][18][19]. Thirty-day mortality in EFsB is around 20% and higher in patients with an abdominal focus of infection and nosocomial infection [13].…”

Mitral valve repair in infective endocarditis: which evidence?

“…Staphylococci at present are the most frequent etiologic organism. A Danish study showed that between 1957 and 1990, Staphylococcus aureus bacteremia increased from 3 to 20 per 100,000 person-years, paralleling the increase of hospital admissions and invasive medical procedures [7] . Hand-hygiene, barrier precautions, and antisepsis are effective measures in reducing the rate of bacteremia.…”

Incidence of infective endocarditis during the coronavirus disease 2019 pandemic: A nationwide study

“…Infective endocarditis (IE) is associated with high morbidity and mortality caused by mainly gram positive cocci [4] , [5] , [6] , [7] , [8] . Recent studies have reported an increasing incidence of IE during the past two decades [9] , [10] , [11] , [12] .…”