Division of Infectious Diseases, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea.
Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Microbiol Spectr. 2023 Aug 17;11(4):e0104923. doi: 10.1128/spectrum.01049-23. Epub 2023 Jun 7.
This study aimed to identify which streptococcal species are closely associated with infective endocarditis (IE) and to evaluate risk factors for mortality in patients with streptococcal IE. We performed a retrospective cohort study of all patients with streptococcal bloodstream infection (BSI) from January 2010 to June 2020 in a tertiary hospital in South Korea. We compared clinical and microbiological characteristics of streptococcal BSIs according to the diagnosis of IE. We performed multivariate analysis to evaluate the risk of IE according to streptococcal species and risk factors for mortality in streptococcal IE. A total of 2,737 patients were identified during the study period, and 174 (6.4%) were diagnosed with IE. The highest IE prevalence was in patients with Streptococcus mutans BSI (33% [9/27]) followed by S. sanguinis (31% [20/64]), S. gordonii (23% [5/22]), S. gallolyticus (16% [12/77]), and S. oralis (12% [14/115]). In multivariate analysis, previous IE, high-grade BSI, native valve disease, prosthetic valve, congenital heart disease, and community-onset BSI were independent risk factors for IE. After adjusting for these factors, S. sanguinis (adjusted OR [aOR], 7.75), S. mutans (aOR, 5.50), and S. gallolyticus (aOR, 2.57) were significantly associated with higher risk of IE, whereas S. pneumoniae (aOR, 0.23) and (aOR, 0.37) were associated with lower risk of IE. Age, hospital-acquired BSI, ischemic heart disease, and chronic kidney disease were independent risk factors for mortality in streptococcal IE. Our study points to significant differences in the prevalence of IE in streptococcal BSI according to species. Our study of risk of infective endocarditis in patients with streptococcal bloodstream infection demonstrated that Streptococcus sanguinis, S. mutans, and S. gallolyticus were significantly associated with higher risk of infective endocarditis. However, when we evaluated the performance of echocardiography in patients with streptococcal bloodstream infection, patients with S. mutans and S. gordonii bloodstream infection had a tendency of low performance in echocardiography. There are significant differences in the prevalence of infective endocarditis in streptococcal bloodstream infection according to species. Therefore, performing echocardiography in streptococcal bloodstream infection with a high prevalence of, and significant association with, infective endocarditis is desirable.
本研究旨在确定与感染性心内膜炎（IE）密切相关的链球菌种，并评估链球菌性 IE 患者的死亡风险因素。我们对韩国一家三级医院 2010 年 1 月至 2020 年 6 月所有链球菌血流感染（BSI）患者进行了回顾性队列研究。我们比较了根据 IE 诊断的链球菌性 BSI 的临床和微生物学特征。我们进行了多变量分析，以根据链球菌种评估 IE 的风险以及链球菌性 IE 患者的死亡风险因素。在研究期间共确定了 2737 例患者，其中 174 例（6.4%）诊断为 IE。链球菌性 BSI 中 IE 发生率最高的是变形链球菌（33%[9/27]），其次是缓症链球菌（31%[20/64]）、戈登链球菌（23%[5/22]）、牛链球菌（16%[12/77]）和口腔链球菌（12%[14/115]）。多变量分析显示，既往 IE、重度 BSI、原生瓣膜疾病、人工瓣膜、先天性心脏病和社区获得性 BSI 是 IE 的独立危险因素。在调整这些因素后，缓症链球菌（调整后的 OR [aOR]，7.75）、变形链球菌（aOR，5.50）和牛链球菌（aOR，2.57）与 IE 风险显著增加相关，而肺炎链球菌（aOR，0.23）和 （aOR，0.37）与 IE 风险降低相关。年龄、医院获得性 BSI、缺血性心脏病和慢性肾脏病是链球菌性 IE 患者死亡的独立危险因素。我们的研究表明，根据链球菌种的不同，链球菌性 BSI 中 IE 的患病率存在显著差异。我们对链球菌性血流感染患者感染性心内膜炎风险的研究表明，缓症链球菌、变形链球菌和牛链球菌与感染性心内膜炎的风险显著增加相关。然而，当我们评估链球菌性血流感染患者的超声心动图表现时，变形链球菌和戈登链球菌血流感染患者的超声心动图表现倾向于低。根据链球菌种的不同，链球菌性血流感染中感染性心内膜炎的患病率存在显著差异。因此，在链球菌性血流感染中，对于感染性心内膜炎患病率较高且与感染性心内膜炎显著相关的链球菌种，进行超声心动图检查是可取的。
