Prevalence of Infective Endocarditis in Enterococcus faecalis Bacteremia

Enterococcus faecalis bacteremia: please do the echo

“…In our opinion, this definition is outdated since health-care associated IE is increasingly important due to the growing population of elderly and comorbid patients with many contacts to the health-care system [1]. Despite the fact, that community-acquired bacteremia is consistently associated to E. faecalis IE, our new data confirm earlier findings that around half of the E. faecalis IE cases (52%) are health-care associated [2]. In that perspective, we suggest that the ESC diagnostic criteria are updated to include health-care associated E. faecalis bacteremia to better reflect contemporary data.…”

“…An earlier retrospective study performed in the same catchment area included 647 patients with E. faecalis bacteremia and found an IE prevalence of 12% [3]. The higher prevalence in our recent study [2] is in part explained by the general increasing prevalence of E. faecalis IE. However, we believe that the substantially lower IE prevalence in the retrospective study is also related to missed cases of IE due to much lower examination rates with TTE in 36% and TEE in 18% of the bacteremia cases [3].…”

“…In a newly published prospective multicenter study using echocardiography to screen E. faecalis bacteremia patients, we found an IE prevalence as high as 26% [2]. The 344 included patients with E. faecalis bacteremia had a mean age of 74 (±12) years confirming that it is indeed a disease of the elderly.…”

“…The 344 included patients with E. faecalis bacteremia had a mean age of 74 (±12) years confirming that it is indeed a disease of the elderly. The key feature of the study was that echocardiography was performed in all patients including transesophageal echocardiography (TEE) in 74% [2]. Transthoracic echocardiography (TTE) missed vegetations in half of the cases where TEE demonstrated vegetations, underlining the importance of TEE [2].…”

“…From analyzing the patient charts, the impression was that the primary reason why these patients were insufficiently examined, was that they were widely spread in different surgical and general internal medicine departments and not referred to an IE specialist nor for cardiac imaging. The combined evidence from these two studies illustrates why it is crucial to perform both TTE and TEE in E. faecalis bacteremia and stress the importance of disseminating this knowledge beyond the narrow spectrum of IE specialists [2,3].…”