Streptococcus agalactiae infective endocarditis: analysis of eight surgical cases from a single centre

Streptococcus agalactiae (GBS) infective endocarditis (IE) is a rare clinical entity. It is associated with a high mortality rate compared to other streptococci endocarditis. The aim of this study is to define the clinical characteristics, treatment and outcomes of a series of eight non-pregnant adults with GBS IE managed by a combination of antibiotics and surgery at our institution.

We retrospectively reviewed the medical records of all adult patients with a definite diagnosis of IE by Duke modified criteria and who underwent surgery at our centre between January 2008 and December 2018.

A total of 190 patients underwent surgery for IE during the study period. Eight cases of GBS IE were identified, including six males and two females. The mean aged was 54 years (range, 32-68). Seven cases suffered native valve endocarditis and one involved an aortic bioprosthesis. Seven patients had underlying comorbidities. Furthermore, four patients had experienced serious complications. Of these, the most common were heart failure, septic shock, and cerebral emboli. Vegetations tended to be large, very mobile, and pedunculated. Most of the patients were treated with penicillin plus an aminoglycoside. Surgery was emergently performed in one patient and urgently performed in seven patients. In- hospital mortality rate was 37.5%.

GBS IE is a virulent disease with an aggressive clinical course. It mostly affects patients with debilitating diseases. Early surgery should be considered to prevent the development of serious complications. However, overall mortality rate remains high despite surgical treatment.