Olmos Carmen, Vilacosta Isidre, Sarriá Cristina, López Javier, Ferrera Carlos, Sáez Carmen, Vivas David, Hernández Miguel, Sánchez-Enrique Cristina, García-Granja Pablo Elpidio, Pérez-Cecilia Elisa, Maroto Luis, San Román José Alberto
Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain.
Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain.
Am Heart J. 2016 Jan;171(1):7-13. doi: 10.1016/j.ahj.2015.10.012. Epub 2015 Oct 21.
Infective endocarditis (IE) due to Streptococcus bovis has been classically associated with elderly patients, frequently involving >1 valve, with large vegetations and high embolic risk, which make it a high-risk group. Our aim is to analyze the current clinical profile and prognosis of S bovis IE episodes, in comparison to those episodes caused by viridans group streptococci and enterococci.
We analyzed 1242 consecutive episodes of IE prospectively recruited on an ongoing multipurpose database, of which 294 were streptococcal left-sided IE and comprised our study group. They were classified into 3 groups: group I (n = 47), episodes of IE due to S bovis; group II (n = 134), episodes due to viridans group streptococci; and group III (n = 113), those episodes due to enterococci.
The incidence of enterococci IE has significantly increased in the last 2 decades (6.4% [1996-2004] vs 11.1% [2005-2013]; P = .005), whereas the incidence of IE due to S bovis and viridans streptococci have remained stable (4% and 10%, respectively). Gender distribution was similar in the 3 groups. Patients with S bovis and enterococci IE were older than those from group II. Nosocomial acquisition was more frequent in group III. Concerning comorbidity, diabetes mellitus (36.7% vs 9.2% vs 26.8%; P < .001) was more common in groups I and III. Chronic renal failure was more prevalent in patients from group III (4.2% vs 1.5% vs 19%; P < .001). Prosthetic valve IE was more frequent in enterococcal IE. Infection upon normal native valves was more frequent in S bovis IE. Colorectal tumors were found in 69% of patients from this group. Vegetation detection was similar in the 3 groups. However, vegetation size was smaller in S bovis IE. During hospitalization, in-hospital complications and in-hospital mortality were higher in enterococci episodes.
S bovis IE accounts for 3.8% of all IE episodes in our cohort; it is associated with a high prevalence of colonic tumors, with predominance of benign lesions, and affects patients without preexisting valve disease. It is related to small vegetations and a low rate of in-hospital complications, including systemic embolisms. In-hospital mortality is similar to that of viridans group streptococci.
牛链球菌所致感染性心内膜炎（IE）传统上与老年患者相关，常累及多个瓣膜，赘生物大且栓塞风险高，使其成为高危群体。我们的目的是分析牛链球菌IE发作的当前临床特征和预后，并与草绿色链球菌和肠球菌所致发作进行比较。
我们分析了前瞻性纳入一个正在进行的多用途数据库中的1242例连续IE发作病例，其中294例为链球菌性左侧IE，构成我们的研究组。它们被分为3组：I组（n = 47），牛链球菌所致IE发作；II组（n = 134），草绿色链球菌所致发作；III组（n = 113），肠球菌所致发作。
在过去20年中，肠球菌IE的发病率显著增加（1996 - 2004年为6.4%，2005 - 2013年为11.1%；P = 0.005），而牛链球菌和草绿色链球菌所致IE的发病率保持稳定（分别为4%和10%）。3组的性别分布相似。牛链球菌和肠球菌IE患者比II组患者年龄更大。III组医院获得性感染更常见。关于合并症，糖尿病在I组和III组更常见（36.7%对9.2%对26.8%；P < 0.001）。慢性肾衰竭在III组患者中更普遍（4.2%对1.5%对19%；P < 0.001）。人工瓣膜IE在肠球菌IE中更常见。正常天然瓣膜感染在牛链球菌IE中更常见。该组69%的患者发现有结直肠肿瘤。3组的赘生物检出情况相似。然而，牛链球菌IE中的赘生物尺寸较小。住院期间，肠球菌发作的院内并发症和院内死亡率更高。
牛链球菌IE占我们队列中所有IE发作的3.8%；它与结肠肿瘤的高患病率相关，以良性病变为主，且影响无既往瓣膜疾病的患者。它与小赘生物和低院内并发症发生率相关，包括系统性栓塞。院内死亡率与草绿色链球菌相似。
