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Bacteraemia and infective endocarditis with Streptococcus bovis-Streptococcus equinus-complex: a retrospective cohort
Jonas Öberg1, Bo Nilson2,3, Patrik Gilje4
1Department of Clinical Sciences Lund, Section for Infection Medicine, Helsingborg Hospital, Lund University, Lund, Sweden.
Infectious Diseases (London, England)
|June 22, 2022
Summary
The risk of infective endocarditis (IE) from Streptococcus bovis/equinus complex (SBSEC) bacteraemia varies by subspecies. Echocardiography is recommended for S. gallolyticus and S. infantarius, but may be omitted for S. pasteurianus and S. lutetiensis.
Area of Science:
- Infectious Diseases
- Cardiology
- Microbiology
Background:
- The Streptococcus bovis/equinus complex (SBSEC) is a known cause of infective endocarditis (IE).
- While S. gallolyticus subsp. gallolyticus causes most SBSEC IE cases, the IE risk from other subspecies remains unclear.
- Understanding subspecies-specific IE risk is crucial for appropriate clinical management.
Purpose of the Study:
- To investigate the clinical presentation of bacteraemia caused by common SBSEC subspecies.
- To determine the proportion of patients with IE among those experiencing SBSEC bacteraemia.
- To compare the IE risk associated with different SBSEC subspecies.
Main Methods:
- A retrospective cohort study analyzed SBSEC bacteraemia cases from 2003-2018 in Skåne Region, Sweden.
- Included subspecies were S. gallolyticus subsp. gallolyticus, S. gallolyticus subsp. pasteurianus, S. lutetiensis, and S. infantarius subsp. infantarius.
- Subspecies identification used whole genome sequencing, and IE diagnosis followed European Society of Cardiology criteria.
Main Results:
- Of 210 SBSEC bacteraemia episodes, 13% (28/210) had definite IE.
- IE proportions varied significantly by subspecies: S. gallolyticus (33%), S. infantarius (16%), S. pasteurianus (5%), and S. lutetiensis (5%).
- S. pasteurianus and S. lutetiensis were more frequently linked to intra-abdominal and polymicrobial infections.
Conclusions:
- The proportion of IE in SBSEC bacteraemia differs substantially based on the specific subspecies.
- Echocardiography is strongly recommended for S. gallolyticus and S. infantarius bacteraemia.
- Echocardiography might be considered optional in cases of S. pasteurianus and S. lutetiensis bacteraemia.
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