Enterococcal endocarditis: 107 cases from the international collaboration on endocarditis merged database.
OBJECTIVE
To describe clinical features and outcomes of enterococcal left-sided native valve endocarditis and to compare it to endocarditis caused by other pathogens.


METHODS
Patients in the International Collaboration on Endocarditis-Merged Database were included if they had left-sided native valve endocarditis. Demographic characteristics, clinical features, and outcomes were analyzed. Multivariable analysis evaluated enterococcus as a predictor of mortality.


RESULTS
Of 1285 patients with left-sided native valve endocarditis, 107 had enterococcal endocarditis. Enterococcal endocarditis was most frequently seen in elderly men, frequently involved the aortic valve, tended to produce heart failure rather than embolic events, and had relatively low short-term mortality. Compared to patients with non-enterococcal endocarditis, patients with enterococcal endocarditis had similar rates of nosocomial acquisition, heart failure, embolization, surgery, and mortality. Compared to patients with streptococcal endocarditis, patients with enterococcal endocarditis were more likely to be nosocomially acquired (9 of 59 [15%] vs 2 of 400 [1%]; P <.0001) and have heart failure (49 of 107 [46%] vs 234 of 666 [35%]; P = 0.03). Compared to patients with S. aureus endocarditis, patients with enterococcal endocarditis were less likely to embolize (28 of 107 [26%] vs 155 of 314 [49%]; P <.0001) and less likely to die (12 of 107 [11%] vs 83 of 313 [27%]; P = 0.001). Multivariable analysis of all patients with left-sided native valve endocarditis showed that enterococcal endocarditis was associated with lower mortality (odds ratio [OR] 0.49; 95% confidence interval [CI] 0.24 to 0.97).


CONCLUSIONS
Enterococcal native valve endocarditis has a distinctive clinical picture with a good prognosis.
Duke University Medical Center, Durham, North Carolin, USA.
J R
JR
McDonald
L
L
Olaison
D J
DJ
Anderson
B
B
Hoen
J M
JM
Miro
S
S
Eykyn
E
E
Abrutyn
V G
VG
Fowler
G
G
Habib
C
C
Selton-Suty
P A
PA
Pappas
C H
CH
Cabell
G R
GR
Corey
F
F
Marco
D J
DJ
Sexton
D000368:Aged; D003937:Diagnosis, Differential; D004452:Echocardiography; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology*; D016983:Enterococcus; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D015994:Incidence; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011664:Pulmonary Valve / Q000000981:diagnostic imaging / Q000473:pathology; D012720:Severity of Illness Index; D013290:Streptococcal Infections / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology; D013291:Streptococcus / Q000302:isolation & purification; D015996:Survival Rate; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000473:pathology; D014481:United States / Q000453:epidemiology