Author + information
- Received February 27, 2019
- Revision received April 8, 2019
- Accepted April 22, 2019
- Published online July 8, 2019.
- Anders Dahl, MD, PhDa,b,∗ (, )@HerlevGentofte,
- Kasper Iversen, MD, DMSca,
- Niels Tonder, MDc,
- Nis Hoest, MD, PhDb,
- Magnus Arpi, MDd,
- Morten Dalsgaard, MD, PhDa,
- Mahtab Chehri, MDe,
- Lars L. Soerensen, MD, PhDa,
- Soren Fanoe, MD, PhDf,
- Soeren Junge, MDg,
- Ulla Hoest, MD, PhDg,
- Nana Valeur, MD, PhDb,
- Trine K. Lauridsen, MD, PhDa,
- Emil Fosbol, MD, PhDf,h,
- Thomas Hoi-Hansen, MD, PhDa and
- Niels E. Bruun, MD, DMSca,i,j,k
- aDepartment of Cardiology, Herlev Gentofte University Hospital, Copenhagen, Denmark
- bDepartment of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark
- cDepartment of Cardiology, Nordsjællands Hospital, Hillerød, Denmark
- dDepartment of Clinical Microbiology, Herlev Gentofte University Hospital, Copenhagen, Denmark
- eDepartment of Clinical Microbiology, Hvidovre University Hospital, Hvidovre, Denmark
- fDepartment of Cardiology, Hvidovre University Hospital, Hvidovre, Denmark
- gDepartment of Cardiology, University Hospital Glostrup, Glostrup, Denmark
- hDepartment of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- iDepartment of Cardiology, Zealand University Hospital, Roskilde, Denmark
- jClinical Institute, Copenhagen University, Copenhagen, Denmark
- kClinical Institute, Aalborg University Hospital, Aalborg, Denmark
- ↵∗Address for correspondence:
Dr. Anders Dahl, Department of Cardiology, Herlev Gentofte University Hospital, Kildegårdsvej 28, Building 8, Third Floor, 2900 Copenhagen, Denmark.
Background Enterococcus faecalis is the third most frequent cause of infective endocarditis (IE). Despite this, no systematic prospective echocardiography studies have examined the prevalence of IE in patients with E. faecalis bacteremia.
Objectives This study sought to determine the prevalence of IE in patients with E. faecalis bacteremia. The secondary objective was to identify predictors of IE.
Methods From January 1, 2014, to December 31, 2016, a prospective multicenter study was conducted with echocardiography in consecutive patients with E. faecalis bacteremia. Predictors of IE were assessed using multivariate logistic regression with backward elimination.
Results A total of 344 patients with E. faecalis bacteremia were included, all examined using echocardiography, including transesophageal echocardiography in 74% of the cases. The patients had a mean age of 74.2 years, and 73.5% were men. Definite endocarditis was diagnosed in 90 patients, resulting in a prevalence of 26.1 ± 4.6% (95% confidence interval [CI]). Risk factors for IE were prosthetic heart valve (odds ratio [OR]: 3.93; 95% CI: 1.76 to 8.77; p = 0.001), community acquisition (OR: 3.35; 95% CI: 1.74 to 6.46; p < 0.001), ≥3 positive blood culture bottles (OR: 3.69; 95% CI: 1.88 to 7.23; p < 0.001), unknown portal of entry (OR: 2.36; 95% CI: 1.26 to 4.40; p = 0.007), monomicrobial bacteremia (OR: 2.73; 95% CI: 1.23 to 6.05; p = 0.013), and immunosuppression (OR: 2.82; 95% CI: 1.20 to 6.58; p = 0.017).
Conclusions This study revealed a high prevalence of 26% definite IE in patients with E. faecalis bacteremia, suggesting that echocardiography should be considered in all patients with E. faecalis bacteremia.
This work was supported by the Research Foundation of the Capital Region of Denmark and the Danish Heart Foundation (grant 13-04-R94-A4470-22761). The study was completely investigator initiated and performed through all its phases. The funders of the study had no influence on study design, data collection, analysis, and interpretation. The funders had no role in writing the manuscript or the decision to submit. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received February 27, 2019.
- Revision received April 8, 2019.
- Accepted April 22, 2019.
- 2019 American College of Cardiology Foundation