Author + information
- Received October 7, 2019
- Revision received November 3, 2019
- Accepted November 19, 2019
- Published online February 3, 2020.
- Juan M. Pericàs, MD, PhD, MPHa,b,
- Jaume Llopis, MD, PhDa,c,
- Patricia Muñoz, MD, PhDd,
- Juan Gálvez-Acebal, MD, PhDe,
- Martha Kestler, MDd,
- Maricela Valerio, MD, PhDd,
- Marta Hernández-Meneses, MDa,
- Miguel Á. Goenaga, MDf,
- Manuel Cobo-Belaustegui, MDg,
- Miguel Montejo, MD, PhDh,
- Guillermo Ojeda-Burgos, MDi,
- M. Dolores Sousa-Regueiro, MDj,
- Arístides de Alarcón, MD, PhDk,
- Antonio Ramos-Martínez, MD, PhDl,
- José M. Miró, MD, PhDa,∗ (, )@idibaps,
- GAMES Investigators∗
- aHospital Clínic de Barcelona, IDIBAPS, Universidad de Barcelona, Barcelona, Spain
- bClinical Direction of Infectious Diseases and Microbiology, IRBLleida, Universitat de Lleida, Lleida, Spain
- cDepartment of Genetics, Microbiology and Statistics, Universitat de Barcelona, Barcelona, Spain
- dHospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- eHospital Universitario Virgen de la Macarena/CSIC/Instituto de Biomedicina de Sevilla (IBiS), Departamento de Medicina, Universidad de Sevilla, Seville, Spain
- fHospital Universitario Donostia, Donostia, Spain
- gHospital Universitario Marqués de Valdecilla, Santander, Spain
- hHospital Universitario Cruces, Barakaldo, Spain
- iClinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Hospital Universitario Virgen de la Victoria, Málaga, Spain
- jServicio de Enfermedades Infecciosas, Complejo Hospitalario A Coruña, A Coruña, Spain
- kClinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Infectious Diseases Research Group Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, Seville, Spain
- lHospital Universitario Puerta de Hierro, IDIPHIM, Majadahonda, Spain
- ↵∗Address for correspondence:
Dr. José M. Miró, Infectious Diseases Service, Hospital Clínic, Villarroel, 170. 08036 Barcelona, Spain.
Background Enterococcal endocarditis (EE) is a growing entity in Western countries. However, quality data from large studies is lacking.
Objectives The purpose of this study was to describe the characteristics and analyze the prognostic factors of EE in the GAMES cohort.
Methods This was a post hoc analysis of a prospectively collected cohort of patients from 35 Spanish centers from 2008 to 2016. Characteristics and outcomes of 516 cases of EE were compared with those of 3,308 cases of nonenterococcal endocarditis (NEE). Logistic regression and Cox proportional hazards regression analysis were performed to investigate risk factors for in-hospital and 1-year mortality, as well as relapses.
Results Patients with EE were significantly older; more frequently presented chronic lung disease, chronic heart failure, prior endocarditis, and degenerative valve disease; and had higher median age-adjusted Charlson score. EE more frequently involved the aortic valve and prosthesis (64.3% vs. 46.7%; p < 0.001; and 35.9% vs. 28.9%; p = 0.002, respectively) but less frequently pacemakers/defibrillators (1.5% vs. 10.5%; p < 0.001), and showed higher rates of acute heart failure (45% vs. 38.3%; p = 0.005). Cardiac surgery was less frequently performed in EE (40.7% vs. 45.9%; p = 0.024). No differences in in-hospital and 1-year mortality were found, whereas relapses were significantly higher in EE (3.5% vs. 1.7%; p = 0.035). Increasing Charlson score, LogEuroSCORE, acute heart failure, septic shock, and paravalvular complications were risk factors for mortality, whereas prior endocarditis was protective and persistent bacteremia constituted the sole risk factor for relapse.
Conclusions Besides other baseline and clinical differences, EE more frequently affects prosthetic valves and less frequently pacemakers/defibrillators. EE presents higher rates of relapse than NEE.
This work was supported by the Ministerio de Sanidad y Consumo of Spain (FIS NCT00871104, Instituto de Salud Carlos III). Institut d’Investigacions Biomèdiques Pi i Sunyer (IDIBAPS) provided a personal 80:20 research grant to Dr. Miró from 2017 to 2019. Dr. Hernandez-Meneses held a Rio Hortega Research Grant (CM17/00062) from the Instituto de Salud Carlos III and the Ministerio de Economia y Competitividad, Madrid, from 2018 to 2020. Dr. Ojeda-Burgos has received grants for assistance to medical meetings from Pfizer, Merck Sharp & Dohme, Gilead, Janssen, and Angelini; and has been paid as a speaker in medical meetings from Janssen, Gilead, and Merck Sharp & Dohme. Dr. Miró has received consulting honoraria and/or research grants from Angelini, Bristol-Myers Squibb, Contrafect, Genentech, Gilead Sciences, Merck Sharp and Dohme, Medtronic, Novartis, Pfizer, and ViiV. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 7, 2019.
- Revision received November 3, 2019.
- Accepted November 19, 2019.
- 2020 American College of Cardiology Foundation
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