Journal List > Infect Chemother > v.44(6) > 1035190

Suh, Kim, Huh, Cho, Kim, Kim, and Bae: Factors Associated with Infective Endocarditis and Predictors of 3-month mortality of Patients with Viridans Streptococcal Bacteremia

Abstract

Background

Viridans streptococci is a major pathogen of infective endocarditis. This study was conducted in order to investigate the factors associated with infective endocarditis and predictors for three-month mortality among patients with viridans streptococcal bacteremia (VSB).

Materials and Methods

In this study, among 261 eligible patients diagnosed as VSB from January 2000 through June 2011 in a university-affiliated hospital, a retrospective analysis of 197 patients was conducted. All patients with VSB were classified into two groups according to sites of bacteremia; infective endocarditis and other infections. Demographic and clinical characteristics were reviewed through electronic medical records factors associated with infective endocarditis and predictors of three-month mortality in VSB patients were evaluated.

Results

Of the 197 patients, 37 (18.8%) patients had viridans streptococcal infective endocarditis (VSIE) and 160 (81.2%) patients had VSB due to other infection. In logistic regression analysis, underlying valvular heart disease (odds ratio [OR], 48.43; 95% confidence interval [CI], 5.77-406.38) and persistent bacteremia (OR, 46.32; 95% CI, 7.18-299.01) showed an independent association with VSIE. Three-month mortality rate was 21.7% in patients with VSB. In logistic regression analysis, previous steroid use (OR, 9.31; 95% CI, 1.34-64.52), previous immunosuppressive therapy (OR, 9.50; 95% CI, 2.13-42.30), hypotension at onset of bacteremia (OR, 7.72, 95% CI, 2.45-24.33), and Charlson comorbidity score ≥3 (OR, 4.53, 95% CI, 1.55-13.28) showed an independent association with three-month mortality in patients with VSB.

Conclusions

VSB patients who have valvular heart disease or persistent bacteremia routinely require echocardiography. Previous steroid use, immunosuppressive therapy, hypotension, and higher Charlson comorbidity score suggested poor prognosis in patients with VSB.

Figures and Tables

Figure 1
Enrollment of patients with Viridans Streptococcal bacteremia.
aSIRS, systemic inflammatory response syndrome
ic-44-419-g001
Table 1
Demographic and Clinical Characteristics of Viridans Streptococcal Bacteremia according to Origins of Bacteremia
ic-44-419-i001

IE, infective endocarditis; SOFA, Sequential Organ Failure Assessment

Data are presented as number (%) of patients, unless otherwise indicated.

aPredisposing factors occurred within three months before bacteremia.

bInvasive procedures included extraction of teeth, percutaneous drainage, endoscopic variceal ligation, endoscopic injection sclerotherapy, etc.

cNeutropenia was defined as absolute neutrophil count <500/mm3 for more than three days.

dPrevious steroid use was defined as ≥ Prednisolone 15 mg/day for more than one week.

ePersistent bacteremia was defined as recovery of a microorganism consistent with infective endocarditis from all of three or a majority of four or more separate blood cultures, with first and last drawn at least one hour apart.

fPersistent fever was defined as persistent fever, even though the patient took adequate antibiotic therapy for 48 hours.

gHypotension was defined as Systolic blood pressure <90 mmHg.

hVascular lesions included major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhage, and Janeway lesions.

iPenicillin MIC by E-test

jInitial adequate antibiotic therapy: Therapy was judged to be either adequate or inadequate on the basis of the in vitro susceptibility of an isolated organism and initiation of antibiotic treatment within 48 hours after bacteremia.

Table 2
Associated Factors for Infective Endocarditis among Patients with Viridans Streptococcal Bacteremia
ic-44-419-i002

OR, odds ratio; C.I, confidence interval; SOFA, Sequential Organ Failure Assessment

*Central venous catheter insertion occurred within three months before bacteremia.

aInvasive procedures included extraction of teeth, percutaneous drainage, endoscopicvariceal ligation, endoscopic injection sclerotherapy, etc.

bNeutropenia was defined as absolute neutrophil count <500/mm3 for more than threedays.

cPersistent bacteremia was defined as recovery of a microorganism consistent with infective endocarditis from all of three or a majority of four or more separate blood cultures, with first and last drawn at least one hour apart.

dPersistent fever was defined as persistent fever, even though the patient took adequate antibiotic therapy for 48 hours.

eVascular lesions included major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhage, and Janeway lesions.

Table 3
Predictors for Three-month Mortality in Patients with Viridans Streptococcal Bacteremia
ic-44-419-i003

OR, odds ratio; C.I, confidence interval; SOFA, Sequential Organ Failure Assessment

aVentilator care was defined as patients who took ventilator care within three months before bacteremia for more than three days.

bPrevious hospital stay occurred care within three months before bacteremia

cPrevious steroid use was defined as ≥ prednisolone 15 mg/day for more than one week.

dHypotension was defined as systolic blood pressure <90 mmHg.

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