A Contemporary Picture of Enterococcal Endocarditis

Area of Science:

• Cardiology
• Infectious Diseases
• Clinical Medicine

Background:

• Enterococcal endocarditis (EE) is an increasing clinical concern in Western nations.
• Large-scale studies with quality data on EE are limited.
• Understanding EE characteristics and outcomes is crucial for patient management.

Purpose of the Study:

• To characterize Enterococcal endocarditis (EE) within the GAMES cohort.
• To identify prognostic factors associated with EE outcomes.
• To compare EE with non-enterococcal endocarditis (NEE) in a large patient cohort.

Main Methods:

• A post hoc analysis of a prospectively collected cohort from 35 Spanish centers (2008-2016).
• Comparison of 516 EE cases with 3,308 NEE cases.
• Logistic regression and Cox proportional hazards models were used to analyze mortality and relapse risk factors.

Main Results:

• EE patients were older, with more comorbidities, and higher rates of aortic valve and prosthetic valve involvement.
• Acute heart failure was more common in EE, while pacemaker/defibrillator use was less frequent.
• In-hospital and 1-year mortality showed no significant difference, but EE had higher relapse rates (3.5% vs. 1.7%).

Conclusions:

• Enterococcal endocarditis (EE) is associated with prosthetic valves and a higher risk of relapse compared to non-enterococcal endocarditis (NEE).
• While mortality rates are comparable, the increased relapse rate in EE necessitates careful monitoring and management strategies.
• Factors like increasing Charlson score and acute heart failure predict mortality, while persistent bacteremia is a key risk factor for relapse in EE.