Key result
Enterococcus faecium endocarditis is linked to more kidney injury but shows similar mortality.
Why the study?
Enterococcus faecium infective endocarditis is an uncommon and therapeutically challenging condition whose clinical phenotype, outcomes, and treatment patterns remained poorly characterized.
Cohort (n=7,014)
Yes
This nationwide registry study characterizes Enterococcus faecium infective endocarditis as a rare entity affecting frail, healthcare-exposed patients, presenting predominantly on native valves with frequent acute kidney injury, fewer intracardiac lesions, and persistently high mortality.
Rare E. faecium IE etiology suggests limited empiric coverage; leaves open outcome and resistance studies in this subgroup.
BACKGROUND: Enterococcus faecium infective endocarditis (IE) is uncommon, therapeutically challenging, and poorly characterized. We aimed to define its clinical phenotype, outcomes, and treatment patterns. METHODS: We performed a prospective multicenter observational study using the Spanish GAMES registry. Episodes of E. faecium IE diagnosed from 2008 through 2024 were compared with IE caused by other etiologies. RESULTS: Among 7014 episodes of IE, 71 (1.0%) were caused by E. faecium. Compared with other etiologies, patients with E. faecium IE were older, had a greater comorbidity burden, and more often had nosocomial acquisition. This syndrome more frequently involved native valves and was associated with more acute kidney injury, but fewer intracardiac complications and lower surgical requirements, although mortality did not differ when compared with other pathogens. Sepsis and surgery indicated but not performed were risk factors for in-hospital death. Treatment was heterogeneous, utilizing several distinct regimens whose clinical use in IE is newly reported. CONCLUSIONS: E. faecium infective endocarditis predominantly affects frail, healthcare-exposed patients and has a distinctive phenotype characterized by native-valve predominance, frequent renal complications, and fewer intracardiac lesions, yet persistently high mortality. These findings help define the clinical profile of this entity and support evaluation of alternative treatment strategies.
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Aparicio‐Minguijón et al. (2026) conducted a cohort in Infective endocarditis (specifically Enterococcus faecium infective endocarditis) (n=7,014). Enterococcus faecium etiology vs. Infective endocarditis caused by other etiologies was evaluated on Clinical phenotype, complications, surgical requirements, and in-hospital mortality. Enterococcus faecium caused 1.0% (71/7014) of infective endocarditis cases, with more native-valve disease and acute kidney injury, fewer intracardiac complications, and similar mortality.
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