Risk of infective endocarditis in oncohaematological patients undergoing active treatment with Enterococcus faecalis...

Enterococcus faecalis bloodstream infections (EF-BSIs) are a common cause of infective endocarditis (IE). Recent guidelines consider E. faecalis bacteraemia a major criterion for IE and recommend systematic echocardiographic screening. The objective of this study was to describe the risk of IE in patients with an EF-BSI and an active oncohaematological malignancy.

We conducted a retrospective multicentre cohort study across three cancer centres in Barcelona, Spain, including all consecutive adults with EF-BSI and active oncohaematological malignancy who had received oncologic treatment within the previous 3 months from January 2014 to December 2023. Patients were identified via microbiology databases. The primary outcome was a diagnosis of definite IE based on European Society of Cardiology criteria. Secondary outcomes included 30-d mortality, 6-month relapse, and cumulative mortality.

A total of 148 patients were included (median age 64.5 y [IQR 57-72]; 53% male). Eighty (54%) patients had a haematological malignancy, and 68 (46%) a solid tumour. Prosthetic heart valves were present in 4 (3%) patients. Most common BSI sources were primary (39, 26%), urinary tract (36, 24%), abdominal or biliary tract (36, 24%), and central venous catheter-related infections (33, 22%). Echocardiography was performed in 22 patients (15%), with only 2 (1%) diagnosed with definite IE: one had a prosthetic valve, and both had persistent bacteraemia. The 30-d mortality rate was 29% and the 6-month cumulative mortality was 55%. Six patients (7%) experienced relapse, with no new IE diagnoses.

Systematic IE screening may not be warranted in this population and should instead be individualised on the basis of clinical risk factors.