Infect Chemother.  2012 Dec;44(6):419-425. 10.3947/ic.2012.44.6.419.

Factors Associated with Infective Endocarditis and Predictors of 3-month mortality of Patients with Viridans Streptococcal Bacteremia

• Suh YS
• Kim MK
• Huh JH
• Cho OH
• Kim JR
• Kim S
• Bae IG

• KMID: 1806923
• DOI: http://doi.org/10.3947/ic.2012.44.6.419

Abstract

BACKGROUND
Viridans streptococci is a major pathogen of infective endocarditis. This study was conducted in order to investigate the factors associated with infective endocarditis and predictors for three-month mortality among patients with viridans streptococcal bacteremia (VSB).
MATERIALS AND METHODS
In this study, among 261 eligible patients diagnosed as VSB from January 2000 through June 2011 in a university-affiliated hospital, a retrospective analysis of 197 patients was conducted. All patients with VSB were classified into two groups according to sites of bacteremia; infective endocarditis and other infections. Demographic and clinical characteristics were reviewed through electronic medical records factors associated with infective endocarditis and predictors of three-month mortality in VSB patients were evaluated.
RESULTS
Of the 197 patients, 37 (18.8%) patients had viridans streptococcal infective endocarditis (VSIE) and 160 (81.2%) patients had VSB due to other infection. In logistic regression analysis, underlying valvular heart disease (odds ratio [OR], 48.43; 95% confidence interval [CI], 5.77-406.38) and persistent bacteremia (OR, 46.32; 95% CI, 7.18-299.01) showed an independent association with VSIE. Three-month mortality rate was 21.7% in patients with VSB. In logistic regression analysis, previous steroid use (OR, 9.31; 95% CI, 1.34-64.52), previous immunosuppressive therapy (OR, 9.50; 95% CI, 2.13-42.30), hypotension at onset of bacteremia (OR, 7.72, 95% CI, 2.45-24.33), and Charlson comorbidity score > or =3 (OR, 4.53, 95% CI, 1.55-13.28) showed an independent association with three-month mortality in patients with VSB.
CONCLUSIONS
VSB patients who have valvular heart disease or persistent bacteremia routinely require echocardiography. Previous steroid use, immunosuppressive therapy, hypotension, and higher Charlson comorbidity score suggested poor prognosis in patients with VSB.

Keyword

Infective endocarditis; Viridans streptococci; Bacteremia; Mortality

MeSH Terms

Bacteremia
Comorbidity
Echocardiography
Electronic Health Records
Endocarditis
Heart Valve Diseases
Humans
Hypotension
Logistic Models
Prognosis
Retrospective Studies
Viridans Streptococci

Figure

• 

  Figure 1 Enrollment of patients with Viridans Streptococcal bacteremia. aSIRS, systemic inflammatory response syndrome

Reference

1. Ergin A. Classical and new approaches in laboratory diagnosis of viridans streptococci. Mikrobiyol Bul. 2010. 44:495–503.

2. Bochud PY, Calandra T, Francioli P. Bacteremia due to viridans streptococci in neutropenic patients: a review. Am J Med. 1994. 97:256–264.

3. Singh KP, Morris A, Lang SD, MacCulloch DM, Bremner DA. Clinically significant Streptococcus anginosus (Streptococcus milleri) infections: a review of 186 cases. N Z Med J. 1988. 101:813–816.

4. Wilson WR, Karchmer AW, Dajani AS, Taubert KA, Bayer A, Kaye D, Bisno AL, Ferrieri P, Shulman ST, Durack DT. Antibiotic treatment of adults with infective endocarditis due to streptococci, enterococci, staphylococci, and HACEK microorganisms. American Heart Association. JAMA. 1995. 274:1706–1713.

5. Tunkel AR, Sepkowitz KA. Infections caused by viridans streptococci in patients with neutropenia. Clin Infect Dis. 2002. 34:1524–1529.

6. Shenep JL. Viridans-group streptococcal infections in immunocompromised hosts. Int J Antimicrob Agents. 2000. 14:129–135.

7. Steckelberg JM, Wilson WR. Risk factors for infective endocarditis. Infect Dis Clin North Am. 1993. 7:9–19.

8. Mylonakis E, Calderwood SB. Infective endocarditis in adults. N Engl J Med. 2001. 345:1318–1330.

9. Chen PL, Lee CC, Li CY, Chang CM, Lee HC, Lee NY, Wu CJ, Shih HI, Tang HJ, Ko WC. A simple scoring algorithm predicting vascular infections in adults with nontyphoid Salmonella bacteremia. Clin Infect Dis. 2012. 55:194–200.

10. Hill EE, Vanderschueren S, Verhaegen J, Herijgers P, Claus P, Herregods MC, Peetermans WE. Risk factors for infective endocarditis and outcome of patients with Staphylococcus aureus bacteremia. Mayo Clin Proc. 2007. 82:1165–1169.

11. Lamas CC, Eykyn SJ. Bicuspid aortic valve--A silent danger: analysis of 50 cases of infective endocarditis. Clin Infect Dis. 2000. 30:336–341.

12. Gersony WM, Hayes CJ, Driscoll DJ, Keane JF, Kidd L, O'Fallon WM, Pieroni DR, Wolfe RR, Weidman WH. Bacterial endocarditis in patients with aortic stenosis, pulmonary stenosis, or ventricular septal defect. Circulation. 1993. 87:2 Suppl. I121–I126.

13. Li W, Somerville J. Infective endocarditis in the grown-up congenital heart (GUCH) population. Eur Heart J. 1998. 19:166–173.

14. Bosshard PP, Kronenberg A, Zbinden R, Ruef C, Böttger EC, Altwegg M. Etiologic diagnosis of infective endocarditis by broad-range polymerase chain reaction: a 3-year experience. Clin Infect Dis. 2003. 37:167–172.

15. Fowler VG Jr, Olsen MK, Corey GR, Woods CW, Cabell CH, Reller LB, Cheng AC, Dudley T, Oddone EZ. Clinical identifiers of complicated Staphylococcus aureus bacteremia. Arch Intern Med. 2003. 163:2066–2072.

16. Chang FY, Peacock JE Jr, Musher DM, Triplett P, MacDonald BB, Mylotte JM, O'Donnell A, Wagener MM, Yu VL. Staphylococcus aureus bacteremia: recurrence and the impact of antibiotic treatment in a prospective multicenter study. . Medicine (Baltimore). 2003. 82:333–339.

17. Hsu RB. Risk factors for nosocomial infective endocarditis in patients with methicillin-resistant Staphylococcus aureus bacteremia. Infect Control Hosp Epidemiol. 2005. 26:654–657.

18. Kaech C, Elzi L, Sendi P, Frei R, Laifer G, Bassetti S, Fluckiger U. Course and outcome of Staphylococcus aureus bacteraemia: a retrospective analysis of 308 episodes in a Swiss tertiary-care centre. Clin Microbiol Infect. 2006. 12:345–352.

19. Mrazova M, Docze A, Buckova E, Bucko L, Kacmarikova M, Grey E, Korcova J, Koprnova J, Saboova Z, Beno P, Karvaj M, Svetlansky I, Ondrus A, Benca J, Taziarova M, Rudinsky B, Krcmery V Jr. Prospective national survey of viridans streptococcal bacteraemia risk factors, antibacterial susceptibility and outcome of 120 episodes. Scand J Infect Dis. 2005. 37:637–641.

20. Spanik S, Trupl J, Kunova A, Botek R, Sorkovska D, Grey E, Studena M, Lacka J, Oravcova E, Krchnakova A, Rusnakova V, Svec J, Krupova I, Grausova S, Stopkova K, Koren P, Krcmery V Jr. Viridans streptococcal bacteraemia due to penicillin-resistant and penicillin-sensitive streptococci: analysis of risk factors and outcome in 60 patients from a single cancer centre before and after penicillin is used for prophylaxis. Scand J Infect Dis. 1997. 29:245–249.