pISSN 2093-2340   eISSN 2092-6448
Indexed in ESCI, PubMed, Scopus, DOAJ and more
Open Access, Peer-reviewed
    Infect Chemother. 2012 Dec;44(6):419-425. Korean.
    Published online Dec 31, 2012.
    https://doi.org/10.3947/ic.2012.44.6.419
    Copyright © 2012 by The Korean Society of Infectious Diseases and Korean Society for Chemotherapy
    Original Article

    Factors Associated with Infective Endocarditis and Predictors of 3-month mortality of Patients with Viridans Streptococcal Bacteremia

    Young Sun Suh,1 Min Kyo Kim,1 Jae Hyung Huh,1 Oh-Hyun Cho,1 Jang Rak Kim,3,4 Sunjoo Kim,2,4 and In-Gyu Bae, 1,4
      • 1Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea.
      • 2Department of Laboratory Medicine, Gyeongsang National University School of Medicine, Jinju, Korea.
      • 3Department of Preventive Medicine, Gyeongsang National University School of Medicine, Jinju, Korea.
      • 4Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea.
    • Correspondence to In-Gyu Bae, M.D. Department of Internal Medicine, Gyeongsang National University School of Medicine, 79 Gangnam-ro, Jinju 660-702, Korea. Tel: +82-55-750-8055, Fax: +82-55-758-9122, Email: ttezebae@gmail.com
    Received April 25, 2012; Revised October 15, 2012; Accepted October 19, 2012.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Abstract

    Background

    Viridans streptococci is a major pathogen of infective endocarditis. This study was conducted in order to investigate the factors associated with infective endocarditis and predictors for three-month mortality among patients with viridans streptococcal bacteremia (VSB).

    Materials and Methods

    In this study, among 261 eligible patients diagnosed as VSB from January 2000 through June 2011 in a university-affiliated hospital, a retrospective analysis of 197 patients was conducted. All patients with VSB were classified into two groups according to sites of bacteremia; infective endocarditis and other infections. Demographic and clinical characteristics were reviewed through electronic medical records factors associated with infective endocarditis and predictors of three-month mortality in VSB patients were evaluated.

    Results

    Of the 197 patients, 37 (18.8%) patients had viridans streptococcal infective endocarditis (VSIE) and 160 (81.2%) patients had VSB due to other infection. In logistic regression analysis, underlying valvular heart disease (odds ratio [OR], 48.43; 95% confidence interval [CI], 5.77-406.38) and persistent bacteremia (OR, 46.32; 95% CI, 7.18-299.01) showed an independent association with VSIE. Three-month mortality rate was 21.7% in patients with VSB. In logistic regression analysis, previous steroid use (OR, 9.31; 95% CI, 1.34-64.52), previous immunosuppressive therapy (OR, 9.50; 95% CI, 2.13-42.30), hypotension at onset of bacteremia (OR, 7.72, 95% CI, 2.45-24.33), and Charlson comorbidity score ≥3 (OR, 4.53, 95% CI, 1.55-13.28) showed an independent association with three-month mortality in patients with VSB.

    Conclusions

    VSB patients who have valvular heart disease or persistent bacteremia routinely require echocardiography. Previous steroid use, immunosuppressive therapy, hypotension, and higher Charlson comorbidity score suggested poor prognosis in patients with VSB.

    Keywords
    Infective endocarditis; Viridans streptococci; Bacteremia; Mortality

    Figures

    Figure 1
    Enrollment of patients with Viridans Streptococcal bacteremia.

    aSIRS, systemic inflammatory response syndrome

    Tables

    Table 1
    Demographic and Clinical Characteristics of Viridans Streptococcal Bacteremia according to Origins of Bacteremia

    Table 2
    Associated Factors for Infective Endocarditis among Patients with Viridans Streptococcal Bacteremia

    Table 3
    Predictors for Three-month Mortality in Patients with Viridans Streptococcal Bacteremia

    References

      1. Ergin A. Classical and new approaches in laboratory diagnosis of viridans streptococci. Mikrobiyol Bul 2010;44:495–503.
      1. Bochud PY, Calandra T, Francioli P. Bacteremia due to viridans streptococci in neutropenic patients: a review. Am J Med 1994;97:256–264.
      1. Singh KP, Morris A, Lang SD, MacCulloch DM, Bremner DA. Clinically significant Streptococcus anginosus (Streptococcus milleri) infections: a review of 186 cases. N Z Med J 1988;101:813–816.
      1. Wilson WR, Karchmer AW, Dajani AS, Taubert KA, Bayer A, Kaye D, Bisno AL, Ferrieri P, Shulman ST, Durack DT. Antibiotic treatment of adults with infective endocarditis due to streptococci, enterococci, staphylococci, and HACEK microorganisms. American Heart Association. JAMA 1995;274:1706–1713.
      1. Tunkel AR, Sepkowitz KA. Infections caused by viridans streptococci in patients with neutropenia. Clin Infect Dis 2002;34:1524–1529.
      1. Shenep JL. Viridans-group streptococcal infections in immunocompromised hosts. Int J Antimicrob Agents 2000;14:129–135.
      1. Steckelberg JM, Wilson WR. Risk factors for infective endocarditis. Infect Dis Clin North Am 1993;7:9–19.
      1. Mylonakis E, Calderwood SB. Infective endocarditis in adults. N Engl J Med 2001;345:1318–1330.
      1. Chen PL, Lee CC, Li CY, Chang CM, Lee HC, Lee NY, Wu CJ, Shih HI, Tang HJ, Ko WC. A simple scoring algorithm predicting vascular infections in adults with nontyphoid Salmonella bacteremia. Clin Infect Dis 2012;55:194–200.
      1. Hill EE, Vanderschueren S, Verhaegen J, Herijgers P, Claus P, Herregods MC, Peetermans WE. Risk factors for infective endocarditis and outcome of patients with Staphylococcus aureus bacteremia. Mayo Clin Proc 2007;82:1165–1169.
      1. Lamas CC, Eykyn SJ. Bicuspid aortic valve--A silent danger: analysis of 50 cases of infective endocarditis. Clin Infect Dis 2000;30:336–341.
      1. Gersony WM, Hayes CJ, Driscoll DJ, Keane JF, Kidd L, O'Fallon WM, Pieroni DR, Wolfe RR, Weidman WH. Bacterial endocarditis in patients with aortic stenosis, pulmonary stenosis, or ventricular septal defect. Circulation 1993;87 2 Suppl:I121–I126.
      1. Li W, Somerville J. Infective endocarditis in the grown-up congenital heart (GUCH) population. Eur Heart J 1998;19:166–173.
      1. Bosshard PP, Kronenberg A, Zbinden R, Ruef C, Böttger EC, Altwegg M. Etiologic diagnosis of infective endocarditis by broad-range polymerase chain reaction: a 3-year experience. Clin Infect Dis 2003;37:167–172.
      1. Fowler VG Jr, Olsen MK, Corey GR, Woods CW, Cabell CH, Reller LB, Cheng AC, Dudley T, Oddone EZ. Clinical identifiers of complicated Staphylococcus aureus bacteremia. Arch Intern Med 2003;163:2066–2072.
      1. Chang FY, Peacock JE Jr, Musher DM, Triplett P, MacDonald BB, Mylotte JM, O'Donnell A, Wagener MM, Yu VL. Staphylococcus aureus bacteremia: recurrence and the impact of antibiotic treatment in a prospective multicenter study. . Medicine (Baltimore) 2003;82:333–339.
      1. Hsu RB. Risk factors for nosocomial infective endocarditis in patients with methicillin-resistant Staphylococcus aureus bacteremia. Infect Control Hosp Epidemiol 2005;26:654–657.
      1. Kaech C, Elzi L, Sendi P, Frei R, Laifer G, Bassetti S, Fluckiger U. Course and outcome of Staphylococcus aureus bacteraemia: a retrospective analysis of 308 episodes in a Swiss tertiary-care centre. Clin Microbiol Infect 2006;12:345–352.
      1. Mrazova M, Docze A, Buckova E, Bucko L, Kacmarikova M, Grey E, Korcova J, Koprnova J, Saboova Z, Beno P, Karvaj M, Svetlansky I, Ondrus A, Benca J, Taziarova M, Rudinsky B, Krcmery V Jr. Prospective national survey of viridans streptococcal bacteraemia risk factors, antibacterial susceptibility and outcome of 120 episodes. Scand J Infect Dis 2005;37:637–641.
      1. Spanik S, Trupl J, Kunova A, Botek R, Sorkovska D, Grey E, Studena M, Lacka J, Oravcova E, Krchnakova A, Rusnakova V, Svec J, Krupova I, Grausova S, Stopkova K, Koren P, Krcmery V Jr. Viridans streptococcal bacteraemia due to penicillin-resistant and penicillin-sensitive streptococci: analysis of risk factors and outcome in 60 patients from a single cancer centre before and after penicillin is used for prophylaxis. Scand J Infect Dis 1997;29:245–249.
    Cited by
    Crossref 3
    Google Scholar 
    MeSH Terms
    Bacteremia
    Comorbidity
    Echocardiography
    Electronic Health Records
    Endocarditis
    Heart Valve Diseases
    Humans
    Hypotension
    Logistic Models
    Prognosis
    Retrospective Studies
    Viridans Streptococci
    Metrics
    Share
    Figures
    slide

    1 / 1

    Tables
    slide
    slide
    slide

    1 / 3

    PERMALINK