Infective endocarditis related to unusual microorganisms: a prospective population-based study

Silvia Limonta (1, 2) , Emmanuelle Cambau (3) , Marie-Line Erpelding (4) , Caroline Piau-Couapel , François Goehringer (5) , Patrick Plesiat (6, 7, 8) , Matthieu Revest (9, 1, 2) , Véronique Vernet-Garnier (10) , Vincent Le Moing (11) , Bruno Hoen (12) , Xavier Duval (13) , Pierre Tattevin (14, 2, 1)

1 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
2 CIC - Centre d'Investigation Clinique [Rennes]
3 EA3964 - Emergence de la résistance bactérienne in vivo
4 CIC - Centre d'investigation clinique [Nancy]
5 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
6 UFC - Université de Franche-Comté
7 LCE - Laboratoire Chrono-environnement (UMR 6249)
8 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
9 Service des maladies infectieuses et réanimation médicale [Rennes] = Infectious Disease and Intensive Care [Rennes]
10 Hôpital universitaire Robert Debré [Reims]
11 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
12 Service des Maladies Infectieuses et Tropicales [CHRU Nancy]
13 IAME (UMR_S_1137 / U1137) - Infection, Anti-microbiens, Modélisation, Evolution
14 BRM - ARN régulateurs bactériens et médecine

Background - Increased access to heart valves through early surgery and progress in molecular microbiology have reduced the proportion of infective endocarditis (IE) with no microbiological documentation and increased the proportion of IE associated with unusual microorganisms. Methods - We performed an ancillary study of a large prospective population-based survey on IE. Unusual-microorganism IE was defined as definite IE (Duke-Li criteria) due to microorganisms other than streptococci, staphylococci, or enterococci. Results - Of 471 cases of documented IE, 46 (9.8%) were due to unusal microorganisms; the following were involved in >1 case: (n = 4), (n = 4), (n = 3), (n = 3), and (n = 2). Cases were documented with blood cultures (n = 37, 80.4%), heart valve polymerase chain reaction (PCR; n = 5), heart valve culture (n = 2), PCR on vertebral biopsy (n = 1), or serology (n = 1). As compared with IE due to staphylococci, streptococci, or enterococci (n = 420), IE due to unusual microorganisms occurred more frequently in patients with previously known heart disease (69.0% vs 44.3%; = .002), prosthetic valve (40.5% vs 18.1%; = .0006), longer duration of fever (mean, 35.1 ± 46.8 days vs 12.5 ± 17.8; = .003), and who were more often nosocomial (38.1% vs 20.2%; = .02). Conclusions - In this population-based study, 9.8% of IE cases were due to unusual microorganisms, with a predominance of anaerobes, yeast, and gram-negative bacilli. As compared with IE related to staphylococci, streptococci, or enterococci, IE cases related to unusual microorganisms were associated with previously known heart disease, prosthetic valve, longer duration of fever, and nosocomial acquisition. Trial registration - ORCID 0000-0003-3617-5411.

Mots clés: Candida sp; Cutibacterium acnes; HACEK; Pseudomonas aeruginosa; endocarditis

Domaines: Sciences du Vivant [q-bio]

Silvia Limonta, Emmanuelle Cambau, Marie-Line Erpelding, Caroline Piau-Couapel, François Goehringer, et al.. Infective endocarditis related to unusual microorganisms: a prospective population-based study. Open Forum Infectious Diseases, 2020, 7 (5), pp.ofaa127. ⟨10.1093/ofid/ofaa127⟩. ⟨hal-02612650⟩