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Non-β-hemolytic Streptococcal Bacteremia in Patients With Heart Valve Prosthesis-Is It Always Infective Endocarditis?
Fanni Toivonen1, Torgny Sunnerhagen1,2, Johannes Lundin1
1Division of Infection Medicine, Department of Clinical Sciences, Lund, Lund University, Lund, Sweden.
Insights
Patients with heart valve prostheses and non-β-hemolytic streptococcal bacteremia face a high risk of infective endocarditis. Shorter antibiotic courses may lead to relapse, highlighting the need for thorough investigation and appropriate treatment duration.
Area of Science:
- Infectious Diseases
- Cardiology
- Microbiology
Background:
- Non-β-hemolytic streptococci are common causes of infective endocarditis (IE).
- Patients with heart valve prostheses (HVP) are at increased risk for IE.
- Non-β-hemolytic streptococcal bacteremia (NBHSB) in HVP patients warrants careful evaluation.
Purpose of the Study:
- To determine the risk of IE in patients with HVP and NBHSB.
- To investigate the rate of NBHSB relapse based on antibiotic treatment duration.
Main Methods:
- Retrospective population-based study of adults with HVP and NBHSB (2015-2018).
- Data collected from medical records using a predefined protocol.
- IE diagnosis based on European Society of Cardiology 2015 criteria.
Main Results:
- 110 NBHSB episodes in 89 HVP patients were analyzed.
- Definite IE occurred in 36% of episodes; possible IE in 64%.
- Seven NBHSB relapses were observed, primarily in patients with possible IE and short antibiotic courses (<14 days).
Conclusions:
- Patients with NBHSB and HVP have a significant risk for IE.
- Thorough investigation and appropriate antibiotic treatment duration are crucial for managing these patients.
- Short-course antibiotic therapy may be associated with an increased risk of NBHSB relapse.
Background:
Non-β-hemolytic streptococci are among the most common causative agents of infective endocarditis (IE). Patients with a heart valve prosthesis (HVP) have a high risk of IE. We aimed to determine the risk for IE in patients with HVP and non-β-hemolytic streptococcal bacteremia (NBHSB) and to study NBHSB relapse depending on treatment duration.
Method:
Adults with HVP and NBHSB from 2015 to 2018 in the region of Skåne, Sweden, were identified through the Clinical Microbiology Laboratory in Lund and evaluated in a population-based investigation. Data were collected from medical records according to a predefined protocol.
Results:
A total of 110 NBHSB episodes in 89 patients with HVP were included. In 40 episodes (36%), the patients had definite IE, in 69 possible IE, and 1 had rejected IE according to the European Society of Cardiology 2015 criteria. Of the 70 patients without a definite diagnosis of IE, 28 (40%) were treated with antibiotics as if they had IE. There were 7 NBHSB relapses, and 6 of these occurred in patients with possible IE. Four relapses occurred in patients who received antibiotics for <14 days. Three patients with possible IE were diagnosed with definite IE at the time of the relapse.
Conclusions:
Patients with NBHSB and HVP have a high risk for IE and should be thoroughly investigated. Most patients with NBHSB and HVP who fulfilled criteria for possible IE did not receive long-course antibiotic treatment. Moreover, some patients treated with a short course of antibiotics experienced NBHSB relapse.
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