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Infective endocarditis due to Streptococcus dysgalactiae: clinical presentation and microbiological features
Anna Bläckberg1, Bo Nilson2,3, Volkan Özenci4,5
1Department of Clinical Sciences, Division of Infection Medicine, Lund University, BMC B14 Baravägen 27, 223 63, Lund, Sweden. anna.blackberg@med.lu.se.
Infective endocarditis caused by Streptococcus dysgalactiae (SD) typically affects elderly individuals with a rapid onset. While some SD isolates showed synergy with penicillin and gentamicin, clinical benefit requires careful consideration of side effects.
Area of Science:
- Infectious Diseases
- Cardiology
- Microbiology
Background:
- Infective endocarditis (IE) caused by Streptococcus dysgalactiae (SD) is not well-characterized.
- Understanding the clinical and microbiological aspects of SD-IE is crucial for effective management.
Purpose of the Study:
- To identify the clinical and microbiological features of SD-IE.
- To investigate potential antibiotic synergy between penicillin and gentamicin against SD isolates.
Main Methods:
- Retrospective analysis of 50 SD-IE cases reported to the Swedish Registry of Infective Endocarditis (2008-2016).
- emm typing of SD isolates.
- Time-kill assays to determine antibiotic synergy (penicillin and gentamicin).
- Comparison of SD-IE cases with IE due to other pathogens.
Main Results:
- The median age of SD-IE patients was 74 years, significantly older than those with Staphylococcus aureus-IE.
- Median time to diagnosis was 1 day, indicating acute onset.
- Embolization occurred in 46% of cases, with an 8% in-hospital mortality rate.
- Synergy between penicillin and gentamicin was observed in time-kill assays for 4/9 isolates, but not with Etest.
Conclusions:
- SD-IE is an acute condition predominantly affecting the elderly.
- While some SD isolates exhibit synergy with penicillin and gentamicin, the therapeutic advantage needs to be balanced against potential aminoglycoside toxicity.
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