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Published on: January 7, 2019
Non-betahemolytic streptococcal bacteremia, cardiac implantable electronic device, endocarditis, extraction, and
Andreas Berge1,2, Johannes Lundin3, Anna Bläckberg3,4
1Unit of Infectious Diseases, Department of Medicine, Solna, Karolinska Institutet, 171 76, Stockholm, Sweden. andreas.berge@regionstockholm.se.
Insights
Patients with cardiac implantable electronic devices (CIED) and non-beta-hemolytic streptococcal bacteremia (NBHSB) have a low risk of infective endocarditis (IE). Most IE cases occurred in patients with simultaneous heart valve prostheses.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Devices
Background:
- Non-beta-hemolytic streptococcal bacteremia (NBHSB) poses a risk for infective endocarditis (IE).
- Cardiac implantable electronic devices (CIED) may increase IE risk.
- Understanding IE and recurrent NBHSB in CIED patients is crucial.
Purpose of the Study:
- To describe a population-based cohort of patients with NBHSB and CIED.
- To identify variables associated with IE in this cohort.
- To investigate factors related to recurrent NBHSB.
Main Methods:
- Retrospective analysis of NBHSB blood culture episodes (2015-2018).
- Identification of patients with CIED during NBHSB.
- Clinical data collection and 365-day follow-up.
Main Results:
- 85 NBHSB episodes in 79 CIED patients were analyzed.
- 10% of patients were diagnosed with IE; most had heart valve prostheses (HVP).
- 30% mortality; 4 patients experienced recurrent NBHSB, three with HVP.
Conclusions:
- The risk of IE in NBHSB patients with CIED is not high.
- IE in this cohort is often associated with co-existing HVP.
- A management algorithm for NBHSB in CIED patients is proposed.
Purpose:
Patients with non-beta-hemolytic streptococcal bacteremia (NBHSB) are at risk of infective endocarditis (IE). Patients with cardiac implantable electronic device (CIED) have been described to have an increased risk of IE. The aim of the study was to describe a population-based cohort of patients with NBHSB and CIED and variables associated with IE and recurrent NBHSB.
Methods:
All episodes with NBHSB in blood culture from 2015 to 2018 in a population of 1.3 million inhabitants were collected from the Clinical Microbiology Laboratory, Lund, Sweden. Through medical records, patients with CIED during NBHSB were identified and clinical data were collected. Patients were followed 365 days after NBHSB.
Results:
Eighty-five episodes in 79 patients with CIED and NBHSB constituted the cohort. Eight patients (10%) were diagnosed with definite IE during the first episode, five of whom also had heart valve prosthesis (HVP). In 39 patients (49%) transesophageal echocardiography (TEE) was performed of which six indicated IE. Four patients had the CIED extracted. Twenty-four patients did not survive (30%) the study period. Four patients had a recurrent infection with NBHSB with the same species, three of whom had HVP and had been evaluated with TEE with a negative result during the first episode and diagnosed with IE during the recurrency.
Conclusion:
The study did not find a high risk of IE in patients with NBHSB and CIED. Most cases of IE were in conjunction with a simultaneous HVP. A management algorithm is suggested.
