Author + information
- Received February 21, 2018
- Revision received March 16, 2018
- Accepted March 17, 2018
- Published online June 11, 2018.
- Isabel Zegri-Reiriz, MD, PhDa,
- Arístides de Alarcón, MD, PhDb,
- Patricia Muñoz, MD, PhDc,
- Manuel Martínez Sellés, MD, PhDd,
- Victor González-Ramallo, MD, PhDe,
- Jose M. Miro, MD, PhDf,
- Carles Falces, MD, PhDg,
- Claudia Gonzalez Rico, MDh,
- Xabier Kortajarena Urkola, MDi,
- José Antonio Lepe, MDb,
- Regino Rodriguez Alvarez, MDj,
- Jose Maria Reguera Iglesias, MDk,
- Enrique Navas, MDl,
- Fernando Dominguez, MD, PhDa,m,∗ (, )
- Pablo Garcia-Pavia, MD, PhDa,n,∗ (, )
- for the Spanish Collaboration on Endocarditis—Grupo de Apoyo al Manejo de la Endocarditis infecciosa en España (GAMES)
- aDepartment of Cardiology, Hospital Universitario Puerta de Hierro, CIBERCV, Madrid, Spain
- bClinical Unit of Infectious Diseases, Microbiology and Preventive Medicine Infecious Diseases Research Group, Institute of Biomedicine of Seville, University of Seville/CSIC/University Hospitals Virgen del Rocío and Virgen Macarena, Seville, Spain
- cDepartment of Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERES, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
- dDepartment of Cardiology, Hospital General Universitario Gregorio Marañón, CIBERCV, Universidad Europea, Universidad Complutense, Madrid, Spain
- eDepartment of Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- fDepartment of Infectious Diseases, Hospital Clínic- Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
- gDepartment of Cardiology, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
- hDepartment of Infectious Diseases, Hospital Universitario Marqués de Valdecilla, Santander, Spain
- iDepartment of Infectious Diseases, Hospital Universitario de Donostia, San Sebastián, Spain
- jDepartment of Infectious Diseases, Hospital Universitario de Cruces, Bilbao, Spain
- kDepartment of Infectious Diseases, Hospital Regional Universitario de Málaga, Málaga, Spain
- lDepartment of Infectious Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain
- mFundación Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- nUniversity Francisco de Vitoria, Pozuelo de Alarcon, Madrid, Spain
- ↵∗Address for correspondence:
Dr. Pablo Garcia-Pavia OR Dr. Fernando Dominguez, Department of Cardiology, Hospital Universitario Puerta de Hierro, Manuel de Falla, 2, Majadahonda, Madrid, 28222, Spain.
Background There is little information concerning infective endocarditis (IE) in patients with bicuspid aortic valve (BAV) or mitral valve prolapse (MVP). Currently, IE antibiotic prophylaxis (IEAP) is not recommended for these conditions.
Objectives This study sought to describe the clinical and microbiological features of IE in patients with BAV and MVP and compare them with those of IE patients with and without IEAP indication, to determine the potential benefit of IEAP in these conditions.
Methods This analysis involved 3,208 consecutive IE patients prospectively included in the GAMES (Grupo de Apoyo al Manejo de la Endocarditis infecciosa en España) registry at 31 Spanish hospitals. Patients were classified as high-risk IE with IEAP indication (high-risk group; n = 1,226), low- and moderate-risk IE without IEAP indication (low/moderate-risk group; n = 1,839), and IE with BAV (n = 54) or MVP (n = 89).
Results BAV and MVP patients had a higher incidence of viridans group streptococci IE than did high-risk group and low/moderate-risk group patients (35.2% and 39.3% vs. 12.1% and 15.0%, respectively; all p < 0.01). A similar pattern was seen for IE from suspected odontologic origin (14.8% and 18.0% vs. 5.8% and 6.0%; all p < 0.01). BAV and MVP patients had more intracardiac complications than did low/moderate-risk group (50% and 47.2% vs. 30.6%, both p < 0.01) patients and were similar to high-risk group patients.
Conclusions IE in patients with BAV and MVP have higher rates of viridans group streptococci IE and IE from suspected odontologic origin than in other IE patients, with a clinical profile similar to that of high-risk IE patients. Our findings suggest that BAV and MVP should be classified as high-risk IE conditions and the case for IEAP should be reconsidered.
This work was supported in part by the Instituto de Salud Carlos III (grants RD012/0042/0066 and CB16/11/00432). Dr. Miro received a personal 80:20 research grant from the Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain during 2017 to 2019. The CNIC is supported by the Ministry of Economy, Industry and Competitiveness and the ProCNIC Foundation, and is a Severo Ochoa Center of Excellence (SEV-2015-0505). Grants from the Instituto de Salud Carlos III and the Spanish Ministry of Economy and Competitiveness are supported by the Plan Estatal de I+D+I 2013-2016—European Regional Development Fund “A way of making Europe.” The funders played no role in the design, collection, analysis, or interpretation of the data or in the decision to submit the manuscript for publication. The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Bernard Prendergast, BMedSChi, BM BS, DM, served as Guest Editor for this paper.
- Received February 21, 2018.
- Revision received March 16, 2018.
- Accepted March 17, 2018.
- 2018 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.