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Enterococcus faecalis bacteraemia and infective endocarditis - what are we missing?

Nye, Clemency, Maxwell, Alice, Hughes, Harriet and Underwood, Jonathan ORCID: 2024. Enterococcus faecalis bacteraemia and infective endocarditis - what are we missing? Clinical Infection in Practice 21 , 100336. 10.1016/j.clinpr.2023.100336

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Introduction Enterococcus faecalis is an increasingly common cause of infective endocarditis, with a recent study by Dahl et al demonstrating a prevalence of 26% of IE when transoesophageal echo was routinely undertaken. Another study undertaken by Østergaard et al found that 16.7% of patients with E. faecalis bacteraemia developed endocarditis. Based on these findings we examined the rates of IE diagnosed in our own health board to determine if our current practice is potentially missing cases of IE and if we could improve our management of these bacteraemias. Methods All blood cultures in patients over 18 which were positive for E. faecalis from October 2017 to March 2022 were reviewed. We analysed the patient characteristics, clinical outcomes and included a follow up period of 6 months to assess for recrudescence and treatment failure. Results The rate of patients with E. faecalis bacteraemia diagnosed with IE was 7.1%. If polymicrobial blood cultures were excluded this rose to 13.0%. Community acquisition, patient cardiac or immune risk factors, monomicrobial culture and multiple positive blood cultures all were associated with IE. 62.1% of patients with E. faecalis bacteraemia did not have an echocardiogram during their admission, due to a variety of reasons. Discussion The lower reported rate of IE in our cohort may be explained by higher proportion of CVC related infections. However, given the low rates of echocardiography and poor correlation of echocardiography use with IE risk factors, it is likely that cases of IE are being missed, particularly in those with multiple risk factors. Despite this, there was no difference in one-year survival between those diagnosed with IE vs without IE. We have delivered education sessions and introduced a multidisciplinary team meeting to discuss infective endocarditis cases to address these issues.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Publisher: Elsevier
ISSN: 2590-1702
Funders: MRC
Date of First Compliant Deposit: 20 December 2023
Date of Acceptance: 4 December 2023
Last Modified: 15 Jan 2024 16:25

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