Prevalence of Infective Endocarditis in Streptococcal Bloodstream Infections Is Dependent on Streptococcal Species

Chamat-Hedemand, Sandra; Dahl, Anders; Østergaard, Lauge; Arpi, Magnus; Fosbøl, Emil Loldrup; Boel, Jonas Bredtoft; Oestergaard, Louise Bruun; Lauridsen, Trine K.; Gislason, Gunnar; Torp‐Pedersen, Christian; Bruun, Niels Eske

doi:10.1161/circulationaha.120.046723

Cited by 105 publications

(112 citation statements)

References 28 publications

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“…1 ). Based on the IE prevalence streptococcal species were classified as low-risk, moderate-risk, high-risk and very high-risk streptococci as described in the main study [ 9 ]. There were 3230 BSI cases (51%) in the low-risk group, 2106 BSI cases (33%) in the moderate-risk group, 556 BSI cases (9%) in the high-risk group, and 501 BSI cases (8%) in the very high-risk group (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…This is a sub-study to a population-based study including adult patients with monospecies streptococcal BSIs admitted from January 1, 2008 to December 31, 2017 in the Capital Region of Denmark (1.5 million people) [ 9 ]. The full method has been described in detail in the main study.…”

Section: Methodsmentioning

confidence: 99%

“…In a recent large cohort study, we showed that different streptococcal species had markedly different IE prevalence, ranging from 1 to 2% in S. pneumoniae and S. pyogenes to almost 50% in S. gordonii and S. mutans [ 9 ]. These findings support the fact that not all streptococcal species carry the same risk of IE and therefore it is highly relevant to consider if the work-up should be differentiated between patients infected with different streptococcal species.…”

Section: Introductionmentioning

confidence: 99%

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Proposal for the use of echocardiography in bloodstream infections due to different streptococcal species

et al. 2021

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Background Infective endocarditis (IE) is diagnosed in 7–8% of streptococcal bloodstream infections (BSIs), yet it is unclear when to perform transthoracic (TTE) and transoesophageal echocardiography (TOE) according to different streptococcal species. The aim of this sub-study was to propose a flowchart for the use of echocardiography in streptococcal BSIs. Methods In a population-based setup, we investigated all patients admitted with streptococcal BSIs and crosslinked data with nationwide registries to identify comorbidities and concomitant hospitalization with IE. Streptococcal species were divided in four groups based on the crude risk of being diagnosed with IE (low-risk < 3%, moderate-risk 3–10%, high-risk 10–30% and very high-risk > 30%). Based on number of positive blood culture (BC) bottles and IE risk factors (prosthetic valve, previous IE, native valve disease, and cardiac device), we further stratified cases according to probability of concomitant IE diagnosis to create a flowchart suggesting TTE plus TOE (IE > 10%), TTE (IE 3–10%), or “wait & see” (IE < 3%). Results We included 6393 cases with streptococcal BSIs (mean age 68.1 years [SD 16.2], 52.8% men). BSIs with low-risk streptococci (S. pneumoniae, S. pyogenes, S. intermedius) are not initially recommended echocardiography, unless they have ≥3 positive BC bottles and an IE risk factor. Moderate-risk streptococci (S. agalactiae, S. anginosus, S. constellatus, S. dysgalactiae, S. salivarius, S. thermophilus) are guided to “wait & see” strategy if they neither have a risk factor nor ≥3 positive BC bottles, while a TTE is recommended if they have either ≥3 positive BC bottles or a risk factor. Further, a TTE and TOE are recommended if they present with both. High-risk streptococci (S. mitis/oralis, S. parasanguinis, G. adiacens) are directed to a TTE if they neither have a risk factor nor ≥3 positive BC bottles, but to TTE and TOE if they have either ≥3 positive BC bottles or a risk factor. Very high-risk streptococci (S. gordonii, S. gallolyticus, S. mutans, S. sanguinis) are guided directly to TTE and TOE due to a high baseline IE prevalence. Conclusion In addition to the clinical picture, this flowchart based on streptococcal species, number of positive blood culture bottles, and risk factors, can help guide the use of echocardiography in streptococcal bloodstream infections. Since echocardiography results are not available the findings should be confirmed prospectively with the use of systematic echocardiography.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Proposal for the use of echocardiography in bloodstream infections due to different streptococcal species

et al. 2021

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“…For the last two decades, a significant rise in incidence of infective endocarditis were observed worldwide (Tripodi et al, 2005;Marmolin et al, 2016;Shahid et al, 2018;Arregle et al, 2019;Chamat-Hedemand et al, 2020). Among 100,000 population, 2.6-7 cases of endocarditis have been reported per year, a significant proportion of which was contributed by streptococcal infections: with incidence of 17% in North America, 31% in other European countries, 39% in the South America, and 32% in rest of the world (Holland et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

Genome-Based Drug Target Identification in Human Pathogen Streptococcus gallolyticus

et al. 2021

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Streptococcus gallolysticus (Sg) is an opportunistic Gram-positive, non-motile bacterium, which causes infective endocarditis, an inflammation of the inner lining of the heart. As Sg has acquired resistance with the available antibiotics, therefore, there is a dire need to find new therapeutic targets and potent drugs to prevent and treat this disease. In the current study, an in silico approach is utilized to link genomic data of Sg species with its proteome to identify putative therapeutic targets. A total of 1,138 core proteins have been identified using pan genomic approach. Further, using subtractive proteomic analysis, a set of 18 proteins, essential for bacteria and non-homologous to host (human), is identified. Out of these 18 proteins, 12 cytoplasmic proteins were selected as potential drug targets. These selected proteins were subjected to molecular docking against drug-like compounds retrieved from ZINC database. Furthermore, the top docked compounds with lower binding energy were identified. In this work, we have identified novel drug and vaccine targets against Sg, of which some have already been reported and validated in other species. Owing to the experimental validation, we believe our methodology and result are significant contribution for drug/vaccine target identification against Sg-caused infective endocarditis.

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“…The species encompassing SAG ( Streptococcus anginosus , Streptococcus intermedius , and Streptococcus constellatus ) are known for their propensity to cause pyogenic infection and abscess formation in the head, neck, or abdomen. SAG can also cause bacteremia and, more rarely, endocarditis [ 6 , 7 ].…”

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confidence: 99%

Clinical Features and Outcomes of Streptococcus anginosus Group Infective Endocarditis: A Multicenter Matched Cohort Study

Escrihuela‐Vidal

López-Cortés

Escolà-Vergé

et al. 2021

Open Forum Infectious Diseases

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Background Although Streptococcus anginosus group (SAG) endocarditis is considered a severe disease associated with abscess formation and embolic events, there is limited evidence to support this assumption. Methods We performed a retrospective analysis of prospectively collected data from consecutive patients with definite SAG endocarditis in 28 centers in Spain and Italy. A comparison between cases due to SAG endocarditis and viridans group streptococci (VGS) or Streptococcus gallolyticus group (SGG) was performed in a 1:2 matched analysis. Results Of 5,336 consecutive cases of definite endocarditis, 72 (1.4%) were due to SAG and matched with 144 cases due to VGS/SGG. SAG endocarditis was community acquired in 64 (88.9%) cases and affected aortic native valve in 29 (40.3%). When comparing SAG and VGS/SGG endocarditis, no significant differences were found in septic shock (8.3% vs. 3.5%, P = 0.116); valve disorder, including perforation (22.2% vs. 18.1%, P = 0.584), pseudoaneurysm (16.7% vs. 8.3%, P = 0.108), or prosthesis dehiscence (1.4% vs. 6.3%, P = 0.170); paravalvular complications, including abscess (25% vs. 18.8%, P = 0.264) and intracardiac fistula (5.6% vs. 3.5%, P = 0.485); heart failure (34.7% vs. 38.9%, P = 0.655); and embolic events (41.7% vs. 32.6%, P = 0.248). Indications for surgery (70.8% vs. 70.8%; P =1) and mortality (13.9% vs. 16.7%; P = 0.741) were similar between groups. Conclusions SAG endocarditis is an infrequent but serious condition that presents a prognosis similar to that of VGS/SGG

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Prevalence of Infective Endocarditis in Streptococcal Bloodstream Infections Is Dependent on Streptococcal Species

Cited by 105 publications

References 28 publications

Proposal for the use of echocardiography in bloodstream infections due to different streptococcal species

Proposal for the use of echocardiography in bloodstream infections due to different streptococcal species

Genome-Based Drug Target Identification in Human Pathogen Streptococcus gallolyticus

Clinical Features and Outcomes of Streptococcus anginosus Group Infective Endocarditis: A Multicenter Matched Cohort Study

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