Prevalence of Infective Endocarditis in Enterococcus faecalis Bacteremia
Key result
E. faecalis bacteremia shows ~26% infective endocarditis prevalence, especially with prosthetic valves and community acquisition.
- 95% CI ± 4.6
- n=344
Why the study?
No systematic prospective echocardiography studies have examined the prevalence of infective endocarditis in patients with Enterococcus faecalis bacteremia.
What is the prevalence of infective endocarditis in patients with Enterococcus faecalis bacteremia evaluated by echocardiography?
Population
344 consecutive patients with Enterococcus faecalis bacteremia
Design
Prospective multicenter observational study with echocardiography
Authors
Discussion
Loading...
Member takes
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“It seems that the more extensively we examine using echocardiography, the higher the detection rate of [infective endocarditis]. This is not surprising, but the question is, do we overlook cases of [infective endocarditis] in the normal clinical routine? The discrepancy in [infective endocarditis] prevalence between our prospective study and the previous studies suggests a substantial underdiagnosis of E. faecalis endocarditis in the general everyday clinic represented by the earlier studies.”
“Referral bias occurs when patients with a particular illness (e.g., IE) are systematically selected in tertiary care centers for inclusion in studies. We are afraid that referral bias might exist in this study and contribute to the high IE prevalence of 26% compared with that of previous studies (4% to 12%).”
“we agree that it is better to overtreat than to fail to treat.”
Implication
Echocardiography may be considered in E. faecalis bacteremia; leaves open whether universal screening improves outcomes in trials.
Key Points
- To determine the prevalence of infective endocarditis and establish clinical predictors of endocardial involvement in patients presenting with Enterococcus faecalis bacteremia.
- Conducted a prospective multicenter study from January 1, 2014, to December 31, 2016, enrolling N=344 consecutive patients with E. faecalis bacteremia.
- All patients underwent echocardiographic evaluation, which included transesophageal echocardiography in 74% of cases.
- Identified independent predictors of infective endocarditis using multivariate logistic regression with backward elimination.
- Definite infective endocarditis was diagnosed in 90 of 344 patients, yielding a prevalence of 26.1% (95% CI: 21.5% to 30.7%).
- Significant independent predictors included prosthetic heart valve (OR: 3.93; 95% CI: 1.76 to 8.77; p = 0.001), ≥3 positive blood culture bottles (OR: 3.69; 95% CI: 1.88 to 7.23; p < 0.001), and community acquisition (OR: 3.35; 95% CI: 1.74 to 6.46; p < 0.001).
- Additional risk factors were immunosuppression (OR: 2.82; 95% CI: 1.20 to 6.58; p = 0.017), monomicrobial bacteremia (OR: 2.73; 95% CI: 1.23 to 6.05; p = 0.013), and unknown portal of entry (OR: 2.36; 95% CI: 1.26 to 4.40; p = 0.007).
Study Design
Type
Observational (n=344)
Multicenter
Yes
Structured PICO
What is the prevalence of infective endocarditis in patients with Enterococcus faecalis bacteremia evaluated by echocardiography?
P
Population
344 consecutive patients with Enterococcus faecalis bacteremia (mean age 74.2 years, 26.5% female) evaluated prospectively with echocardiography.
E
Exposure
Echocardiography (including transesophageal echocardiography in 74% of cases)
O
Outcome
Prevalence of infective endocarditis
There is a high prevalence (26%) of definite infective endocarditis in patients with E. faecalis bacteremia, suggesting echocardiography should be considered in all such patients.
Cite This Study
Dahl et al. (2019) conducted an observational in Enterococcus faecalis bacteremia (n=344). Enterococcus faecalis bacteremia was evaluated on Prevalence of definite infective endocarditis (95% CI ± 4.6). In patients with Enterococcus faecalis bacteremia, the prevalence of definite infective endocarditis was 26.1%, with prosthetic heart valves and community acquisition identified as significant risk factors.