Enterococcal Endocarditis: Prospective Data from the Iranian Registry of Infective Endocarditis

BACKGROUND: Enterococci are responsible for ۵% to ۱۸% of infective endocarditis (IE) cases. We aimed to determine demographic data, predisposing factors, clinical presentations, complications and echocardiographic findings concerning enterococcal endocarditis.METHODS: Since ۲۰۰۶, all adult patients with a possible or definite diagnosis of IE based on the modified Duke criteria have been enrolled in the Iranian Registry of Infective Endocarditis. In this study, patients with IE of enterococcal origin were detected and their demographic characteristics, predisposing factors, complications, laboratory data and echocardiographic findings were assessed.RESULTS: Out of ۷۳۱ patients diagnosed with endocarditis. Enterococci were found in ۶۰ patients: ۳۲ men (۵۳.۳%) and ۲۸ women (۴۶.۷%) at a mean age of ۵۵.۲۱ ± ۱۷.۹ years. Definite IE was diagnosed in ۵۷ (۹۵%) patients, and possible IE was suspected in ۳ patients (۵%). The most frequent predisposing factor was the prosthetic valve (n=۲۸, ۴۶.۷%), followed by a history of previous endocarditis (n=۱۲, ۲۰%). An acute course (<۶ wk) was reported in ۳۸ patients (۶۳.۳%). Fever (n=۵۸, ۹۵%) and loss of appetite (n=۱۷, ۲۸.۳%) were the most frequent symptoms. The most frequent location of involvement was the aortic valve (n=۲۲, ۳۶.۷%), followed by the mitral valve (n=۲۰,۳۳.۳%). Vegetation was detected in ۵۳ patients (۸۸.۳%), abscess formation in ۸ (۱۳%). Fifteen patients (۲۵%) had heart failure, and ۱۱ (۱۸%) had central nervoussystem complications. The mortality rate was ۲۰%.CONCLUSION: Given the serious complications and the high mortality rate in the patients with IE of enterococcal origin, which may be due to these organisms’ intrinsic resistance to many antibiotics, we suggest further studies to determine more effective antibiotic regimens and even individualized antibiotic therapies for enterococcal endocarditis.

Keywords:

Endocarditis , Enterococcus , Staphylococcus aureus