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Updated: May 3, 2026
05:02
A 1.5 Hour Procedure for Identification of Enterococcus Species Directly from Blood Cultures
Published on: February 10, 2011
21.3K
Enterococcus faecalis bacteraemia and infective endocarditis - what are we missing?
Clemency Nye1, Alice Maxwell1, Harriet Hughes1
1Public Health Wales, University Hospital of Wales, Heath Park, Cardiff, CF14 XW.
Clinical Infection in Practice
|February 26, 2024
Summary
Enterococcus faecalis infective endocarditis (IE) may be underdiagnosed. Many patients with E. faecalis bacteremia did not receive echocardiograms, suggesting missed IE cases and potential for improved management.
Area of Science:
- Infectious Diseases
- Cardiology
- Microbiology
Background:
- Enterococcus faecalis is a significant cause of infective endocarditis (IE).
- Previous studies indicate a notable percentage of E. faecalis bacteremia cases progress to IE.
- Current diagnostic practices and IE management for E. faecalis bacteremia require evaluation.
Purpose of the Study:
- To assess the rate of IE diagnosis in patients with E. faecalis bacteremia within a specific health board.
- To identify potential underdiagnosis of IE and opportunities for improved management strategies.
- To evaluate current practices against established IE prevalence rates.
Main Methods:
- Retrospective review of blood cultures positive for E. faecalis in adult patients (October 2017 - March 2022).
- Analysis of patient demographics, clinical characteristics, and outcomes, including a 6-month follow-up for treatment failure.
- Assessment of echocardiogram utilization and correlation with risk factors for IE.
Main Results:
- The diagnosed IE rate in E. faecalis bacteremia patients was 7.1% (13.0% excluding polymicrobial cultures).
- Factors associated with IE included community acquisition, cardiac/immune risk factors, monomicrobial, and multiple positive blood cultures.
- A significant proportion (62.1%) of patients did not undergo echocardiography during admission.
Conclusions:
- A lower IE rate in this cohort may be linked to a higher prevalence of CVC-related infections.
- Underdiagnosis of IE is likely due to low echocardiography rates and inconsistent application based on risk factors.
- Despite potential underdiagnosis, one-year survival did not differ between IE and non-IE groups; educational interventions and multidisciplinary meetings have been implemented.
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