Prevalence of infective endocarditis in patients with positive blood cultures: a Danish nationwide study

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  • Lauge Østergaard, Department of Cardiology, The Unit for Inherited Cardiac Diseases, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark.
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  • Niels Eske Bruun, Clinical Institutes, Copenhagen and Aalborg Universities, Søndre Skovvej 15, 4000 Aalborg, Denmark.
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  • Marianne Voldstedlund, Department of Virology/Epidemiology Research, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark.
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  • Magnus Arpi, Department of Clinical Microbiology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev Ringvej 75, 2730 Herlev, Denmark. Electronic address: bente.ruth.scharvik.olesen@regionh.dk.
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  • Christian Østergaard Andersen, Department of Clinical Microbiology, Amager-Hvidovre Hospital, Kettegård Alle 30, 2650 Hvidovre, Denmark.
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  • Henrik C Schønheyder
  • Lars Lemming, Department of Clinical Microbiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, N, Denmark.
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  • Flemming Rosenvinge, Department of Clinical Microbiology, Odense University Hospital, JB Winsløws vej 21, 5000 Odense, Denmark.
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  • Nana Valeur, Department of Cardiology, Bispebjerg Hospital, Bispebjerg bakke 23, 2400 Copenhagen, Denmark.
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  • Peter Søgaard, Department of Neurosurgery, Aalborg University Hospital, and Institute of Clinical Medicine, Aalborg University, Hobrovej 18-22, DK-9000, Aalborg, Denmark.
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  • Paal Skytt Andersen, Department of Veterinary and Animal Sciences, Faculty of Health and Medical Science, University of Copenhagen, Grønnegårdsvej 15, 1870 Frederiksberg, Denmark.
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  • Robert Skov, Department of Virology/Epidemiology Research, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark.
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  • Ming Chen, Department of Clinical Microbiology, Hospital of Southern Jutland, Sydvang 1, 6400 Sønderborg, Denmark. Electronic address: ming.chen@rsyd.dk.
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  • Kasper Iversen, Department of Cardiology, Herlev-Gentofte Hospital, Herlev Ringvej 75, 2730 Herlev, Denmark.
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  • Sabine Gill, Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, DK-5000 Odense C, Denmark.
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  • Trine Kiilerich Lauridsen, Department of Cardiology, Herlev-Gentofte Hospital, Herlev Ringvej 75, 2730 Herlev, Denmark.
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  • Anders Dahl, Department of Cardiology, Herlev-Gentofte Hospital, Herlev Ringvej 75, 2730 Herlev, Denmark.
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  • Louise Bruun Oestergaard, Department of Neurosurgery, Aalborg University Hospital, and Institute of Clinical Medicine, Aalborg University, Hobrovej 18-22, DK-9000, Aalborg, Denmark.
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  • Jonas Agerlund Povlsen
  • Claus Moser, Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Denmark. Electronic address: claus.moser@regionh.dk.
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  • Henning Bundgaard, Department of Cardiology, The Unit for Inherited Cardiac Diseases, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark.
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  • Lars Køber, Department of Cardiology, The Unit for Inherited Cardiac Diseases, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark.
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  • Emil Loldrup Fosbøl, Department of Cardiology, The Unit for Inherited Cardiac Diseases, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark.

AIMS: Increasing attention has been given to the risk of infective endocarditis (IE) in patients with certain blood stream infections (BSIs). Previous studies have been conducted on selected patient cohorts, yet unselected data are sparse. We aimed to investigate the prevalence of IE in BSIs with bacteria typically associated with IE.

METHODS AND RESULTS: By crosslinking nationwide registries from 2010 to 2017, we identified patients with BSIs typically associated with IE: Enterococcus faecalis (E. faecalis), Staphylococcus aureus (S. aureus), Streptococcus spp., and coagulase negative staphylococci (CoNS) and examined the concurrent IE prevalence. A trend test was used to examine temporal changes in the prevalence of IE. In total 69 021, distributed with 15 350, 16 726, 19 251, and 17 694 BSIs were identified in the periods of 2010-2011, 2012-2013, 2014-2015, and 2016-2017, respectively. Patients with E. faecalis had the highest prevalence of IE (16.7%) followed by S. aureus (10.1%), Streptococcus spp. (7.3%), and CoNS (1.6%). Throughout the study period, the prevalence of IE among patients with E. faecalis and Streptococcus spp. increased significantly (P = 0.0005 and P = 0.03, respectively). Male patients had a higher prevalence of IE for E. faecalis, Streptococcus spp., and CoNS compared with females. A significant increase in the prevalence of IE was seen for E. faecalis, Streptococcus spp., and CoNS with increasing age.

CONCLUSION: For E. faecalis BSI, 1 in 6 had IE, for S. aureus BSI 1 in 10 had IE, and for Streptococcus spp. 1 in 14 had IE. Our results suggest that screening for IE seems reasonable in patients with E. faecalis BSI, S. aureus BSI, or Streptococcus spp. BSI.

Original languageEnglish
JournalEuropean Heart Journal
ISSN0195-668X
DOIs
Publication statusE-pub ahead of print - 30 May 2019

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