title: Characteristics and Outcome of Streptococcus pneumoniae Endocarditis in the XXI Century: A Systematic Review of 111 Cases (2000-2013).
abstract: Streptococcus pneumoniae is an infrequent cause of severe infectious endocarditis (IE). The aim of our study was to describe the epidemiology, clinical and microbiological characteristics, and outcome of a series of cases of S. pneumoniae IE diagnosed in Spain and in a series of cases published since 2000 in the medical literature. We prospectively collected all cases of IE diagnosed in a multicenter cohort of patients from 27 Spanish hospitals (n = 2539). We also performed a systematic review of the literature since 2000 and retrieved all cases with complete clinical data using a pre-established protocol. Predictors of mortality were identified using a logistic regression model. We collected 111 cases of pneumococcal IE: 24 patients from the Spanish cohort and 87 cases from the literature review. Median age was 51 years, and 23 patients (20.7%) were under 15 years. Men accounted for 64% of patients, and infection was community-acquired in 96.4% of cases. The most important underlying conditions were liver disease (27.9%) and immunosuppression (10.8%). A predisposing heart condition was present in only 18 patients (16.2%). Pneumococcal IE affected a native valve in 93.7% of patients. Left-sided endocarditis predominated (aortic valve 53.2% and mitral valve 40.5%). The microbiological diagnosis was obtained from blood cultures in 84.7% of cases. In the Spanish cohort, nonsusceptibility to penicillin was detected in 4.2%. The most common clinical manifestations included fever (71.2%), a new heart murmur (55%), pneumonia (45.9%), meningitis (40.5%), and Austrian syndrome (26.1%). Cardiac surgery was performed in 47.7% of patients. The in-hospital mortality rate was 20.7%. The multivariate analysis revealed the independent risk factors for mortality to be meningitis (OR, 4.3; 95% CI, 1.4-12.9; P < 0.01). Valve surgery was protective (OR, 0.1; 95% CI, 0.04-0.4; P < 0.01). Streptococcus pneumoniae IE is a community-acquired disease that mainly affects native aortic valves. Half of the cases in the present study had concomitant pneumonia, and a considerable number developed meningitis. Mortality was high, mainly in patients with central nervous system (CNS) involvement. Surgery was protective.
authors.affiliation: From the Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón (VDE, PM, MV, MM, EB); Department of Medicine, Universidad Complutense, Madrid (UCM), Spain (PM, MM, EB); CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III (CIBERES), Madrid, Spain (PM, MM, EB); Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM) Madrid, Spain (PM, MV, MM, EB); Microbiology and Infectious disease department, Hospital Universitario Virgen del Rocio, Sevilla (ADA, JAL); Infectious Diseases Department. Hospital Clinic-IDIBAPS, University of Barcelona (Barcelona) (JMM); Department of Medicine, Unidad Clínica Intercentros de Enfermedades Infecciosas, Microbiolo gía y Medicina Preventiva Hospital Universitario Virgen Macarena. Departamento de Medicina. Universidad de Sevilla (JG-A); Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid (PG-P); Hospital Ramón y Cajal, Madrid (EN); UEI HU Donostia, San Sebastián (MAG); Hospital Marqués de Valdecilla, University of Catabria, Santander (MCF); and Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB), Facultad de Medicina-Universidad de Murcia, Spain (EGV).
authors.forename: Viviana
authors.initials: V
authors.lastname: de Egea
authors.forename: Patricia
authors.initials: P
authors.lastname: Muñoz
authors.forename: Maricela
authors.initials: M
authors.lastname: Valerio
authors.forename: Arístides
authors.initials: A
authors.lastname: de Alarcón
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Lepe
authors.forename: José M
authors.initials: JM
authors.lastname: Miró
authors.forename: Juan
authors.initials: J
authors.lastname: Gálvez-Acebal
authors.forename: Pablo
authors.initials: P
authors.lastname: García-Pavía
authors.forename: Enrique
authors.initials: E
authors.lastname: Navas
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Goenaga
authors.forename: María Carmen
authors.initials: MC
authors.lastname: Fariñas
authors.forename: Elisa García
authors.initials: EG
authors.lastname: Vázquez
authors.forename: Mercedes
authors.initials: M
authors.lastname: Marín
authors.forename: Emilio
authors.initials: E
authors.lastname: Bouza
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures; D015897:Comorbidity; D004697:Endocarditis, Bacterial / Q000382:microbiology / Q000503:physiopathology* / Q000628:therapy*; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000503:physiopathology; D011008:Pneumococcal Infections / Q000188:drug therapy* / Q000503:physiopathology*; D013030:Spain; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents