Nonenterococcal group D streptococcal septicemia: association with unrecognized endocarditis

Area of Science:

• Infectious Diseases
• Cardiology
• Internal Medicine

Background:

• Nonenterococcal group D streptococcal septicemia is a serious condition.
• A significant proportion of patients present with polymicrobial bacteremia.
• Colorectal diseases and carcinoma are potential associated conditions.

Purpose of the Study:

• To retrospectively evaluate the incidence of infective endocarditis in patients with nonenterococcal group D streptococcal septicemia.
• To assess the diagnostic accuracy of clinical assessment versus strict criteria for infective endocarditis.
• To determine the impact of early diagnosis and treatment on mortality.

Main Methods:

• Retrospective chart review of 68 patients with nonenterococcal group D streptococcal septicemia.
• Application of strict diagnostic criteria for definite, probable, and possible infective endocarditis.
• Analysis of predisposing heart disease, embolic phenomena, and electrocardiographic abnormalities.

Main Results:

• Only 10% were clinically diagnosed with infective endocarditis, but retrospective analysis revealed 1% definite, 24% probable, and 57% possible endocarditis.
• 40% had predisposing heart disease, and 75% showed signs of embolic phenomena.
• The overall mortality was 62%, but it was significantly lower (14%) in clinically diagnosed and treated infective endocarditis cases.

Conclusions:

• Nonenterococcal septicemia frequently presents with or leads to infective endocarditis, often undiagnosed clinically.
• Patients with nonenterococcal septicemia and cardiac/embolic signs should be suspected of having endocarditis.
• Treating suspected infective endocarditis aggressively may reduce the high mortality associated with this condition.