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Streptococcus bovis bacteraemia: an evaluation of the long-term effect on cardiac outcomes
Gerard J Fitzmaurice1, Adrian J McKenna, Jamie Murphy
1Department of Cardiothoracic Surgery, The Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, Northern Ireland, UK, gfitzmaurice@doctors.org.uk.
Insights
Streptococcus bovis endocarditis can lead to serious heart issues, particularly in patients with prosthetic valves. However, long-term survival for these patients is comparable to those with non-endocarditic bacteraemia.
Area of Science:
- Cardiology
- Infectious Diseases
- Microbiology
Background:
- Streptococcus bovis is a pathogen capable of causing serious bloodstream infections, including bacteraemia, septicaemia, and infective endocarditis.
- Infective endocarditis, particularly when caused by S. bovis, can have significant long-term consequences on cardiac health.
Purpose of the Study:
- To evaluate the long-term cardiac morbidity and mortality associated with Streptococcus bovis endocarditis.
- To identify specific patient populations and risk factors associated with S. bovis endocarditis.
Main Methods:
- A retrospective cohort study was conducted from January 2000 to March 2009.
- Patients diagnosed with S. bovis bacteraemia were identified and assessed for infective endocarditis via echocardiography.
- Primary endpoints included endocarditis diagnosis, while secondary endpoints were cardiac surgery referral and overall mortality.
Main Results:
- Seven out of 43 patients (16.3%) were diagnosed with S. bovis infective endocarditis.
- Four patients had native valve involvement, and three had prosthetic valve infections.
- Patients with endocarditis showed similar long-term survival rates (57.1%) compared to those with non-endocarditic bacteraemia (50%).
- Prosthetic valve endocarditis was associated with higher surgical intervention and relapse rates (100% recurrence in valve replacement patients).
- A significant proportion of patients with endocarditis (6/7) had co-existing colorectal pathology.
Conclusions:
- Streptococcus bovis endocarditis patients often have pre-existing valvular heart disease.
- Prosthetic valve involvement increases the need for surgical intervention and relapse rates.
- Despite associated colorectal pathology, long-term outcomes for S. bovis endocarditis patients are currently reasonable.
- An early surgical strategy may be beneficial for optimizing long-term results in this patient population, warranting further investigation.
Introduction:
Streptococcus bovis can lead to bacteraemia, septicaemia, and ultimately endocarditis. The objective of this study was to evaluate the long-term implications of S. bovis endocarditis on cardiac morbidity and mortality.
Methods:
A retrospective cohort study was performed between January 2000 and March 2009 to assess all patients diagnosed with S. bovis bacteraemia from the Belfast Health and Social Care Trust. The primary end-point for cardiac investigations was the presence of endocarditis. Secondary end-points included referral for cardiac surgery and overall mortality.
Results:
Sixty-one positive S. bovis blood cultures from 43 patients were included. Following echocardiography, seven patients were diagnosed with infective endocarditis (16.3 % of total patients); four patients (9.3 %) had native valve involvement while three (7.0 %) had prosthetic valve infection. Five of these seven patients had more than one positive S. bovis culture (71.4 %). Three had significant valve dysfunction that warranted surgical repair/replacement, one of whom was unfit for surgery. There was a 100 % recurrence rate amongst the valve replacement patients (n = 2) and six patients with endocarditis had colorectal pathology. Patients with endocarditis had similar long-term survival as those with non-endocarditic bacteraemia (57.1 % alive vs. 50 % of non-endocarditis patients, p = 0.73).
Conclusion:
Streptococcus bovis endocarditis patients tended to have pre-existing valvular heart disease and those with prosthetic heart valves had higher surgical intervention and relapse rates. These patients experienced a higher rate of co-existing colorectal pathology but currently have reasonable long-term outcomes. This may suggest that they represent a patient population that merits consideration for an early surgical strategy to maximise long-term results, however, further evaluation is warranted.
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