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Left-sided infective endocarditis caused by Streptococcus agalactiae: rare and serious

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European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

A comparative study of the behaviour of left-sided infective endocarditis (left-sided IE) due to Streptococcus agalactiae (GBS) with left-sided IE caused by Staphylococcus aureus (SA). A prospective, multicentre cohort study in eight public hospitals in Spain, from January 1984 to December 2015; comparative analysis and factors associated with mortality. In total, there were 1754 episodes of left-sided IE; 41 (2.3%) caused by GBS vs. 344 (19.6%) due to SA, definitive IE 39 vs. 324 cases, males, 25 vs. 213, respectively. There were no differences in age or comorbidity, and healthcare-associated acquirement was 10% vs. 43%, p 0.001. Transthoracic echocardiogram (TTE) was performed in 95% vs. 96.8% and a transesophageal echocardiogram (TEE) in 61% vs. 56%. Vegetations were detected in 80% and measured > 1 cm in a similar proportion. It affected native valves in 85.4% vs. 82.6% and late prosthetic valve in 14.6% vs. 9.6%. The course was acute in both groups. There were more skin manifestations in SA left-sided IE, 7.3% vs. 32%, p 0.001. Both groups had similar complications, but in SA, there was more renal failure, 24% vs. 45%, p 0.010. Surgical risk and operated patients were similar. Mortality was proportionally higher in the SA group, without significance 29% vs. 43% (150), p 0.09. Heart failure, septic shock and neurological deterioration conditioned mortality: HR 1.96, 1.69 and 1.37 (CI 95% 1.40–2.73; 1.19–2.39 and 0.99–1.88 respectively) and to a lesser degree SA as aetiology agent and age. Left-sided IE caused by GBS is similar in severity to left-sided IE caused by SA.

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Authors and Affiliations

  1. Servicio de Medicina Interna, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Clínico Universitario “Virgen de la Victoria”, Málaga, Spain

    Radka Ivanova-Georgieva

  2. UGC de Enfermedades Infecciosas, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Clínico Universitario “Virgen de la Victoria”, Málaga, Spain

    Josefa Ruiz-Morales

  3. Delos Clinical Clinical Research Organization, Seville, Spain

    Emilio García-Cabrera

  4. Servicio de Microbiologia Clínica, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Clínico Universitario “Virgen de la Victoria”, Málaga, Spain

    María Victoria García-López

  5. UGC de Enfermedades Infecciosas, Instituto de Biomedicina de Sevilla, IBiS, Hospital Universitario Virgen Macarena. CSIC, Universidad de Sevilla, Seville, Spain

    Juan Gálvez-Acebal

  6. Servicio de Enfermedades Infecciosas, Hospital Regional Universitario de Málaga, Málaga, Spain

    Antonio Plata-Ciezar

  7. Grupo de Enfermedades Infecciosas de la Unidad de Medicina Interna, Hospital Costa del Sol. Marbella, Málaga, Spain

    Javier de la Torre Lima

  8. UGC de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves, Complejo Hospitalario Universitario de Granada, Granada, Spain

    Carmen Hidalgo-Tenorio

  9. UGC de Enfermedades Infecciosas, Complejo Hospitalario Universitario de Huelva, Huelva, Spain

    Francisco Javier Martínez-Marcos

  10. Servicio de Medicina Interna-Enfermedades Infecciosas, Hospital Clínico San Cecilio-CHUG, Granada, Spain

    David Vinuesa García

  11. UGC de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Servicio de E. Infecciosas, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Seville, Spain

    Rafael Luque & Arístides de Alarcón González

Authors
  1. Radka Ivanova-Georgieva
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  2. Josefa Ruiz-Morales
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  3. Emilio García-Cabrera
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  4. María Victoria García-López
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  5. Juan Gálvez-Acebal
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  6. Antonio Plata-Ciezar
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  7. Javier de la Torre Lima
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  8. Carmen Hidalgo-Tenorio
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  9. Francisco Javier Martínez-Marcos
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  10. David Vinuesa García
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  11. Rafael Luque
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  12. Arístides de Alarcón González
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Corresponding author

Correspondence to Radka Ivanova-Georgieva.

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All procedures followed were in accordance with the ethical standards. Informed consent was obtained from all patients for being included in the study.

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The authors declare that they have no conflict of interest.

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Ivanova-Georgieva, R., Ruiz-Morales, J., García-Cabrera, E. et al. Left-sided infective endocarditis caused by Streptococcus agalactiae: rare and serious. Eur J Clin Microbiol Infect Dis 38, 265–275 (2019). https://doi.org/10.1007/s10096-018-3423-3

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  • DOI: https://doi.org/10.1007/s10096-018-3423-3

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