A Contemporary Picture of Enterococcal Endocarditis

Llopis, Jaume; Kestler, Martha; Cobo-Belaustegui, Manuel; Ojeda-Burgos, Guillermo; Sousa-Regueiro, M. Dolores; Ramos‐Martínez, Antonio; Sánchez, Fernando Fernández; Noureddine, Mariam; Rosas, Gabriel; Lima, Javier de la Torre; Blanco, Roberto; Boado, María Victoria; Lázaro, Marta Campaña; Crespo, Alejandro; Goikoetxea, Josune; Iruretagoyena, José Ramón; Zuazabal, Josu Irurzun; López‐Soria, Leire; Montejo, Miguel; Nieto, Javier; Rodrigo, David; Rodríguez, Regino; Vitoria, Yolanda; Voces, Roberto; López, Ma Victoria García; Georgieva, Radka Ivanova; Ojeda, Guillermo; Bailón, Isabel Rodríguez; Morales, Josefa Ruíz; Cuende, Ana María; Echeverría, Tomás; Fuerte, Ana; Gaminde, Eduardo; Goenaga, Miguel Ángel; Idígoras, Pedro; Iribarren, José Antonio; Yarza, Alberto Izaguirre; Urkola, Xabier Kortajarena; Reviejo, Carlos; Carrasco, Rafael; Climent, Vicente; Llamas, Patricio; Merino, Esperanza; Plazas, Joaquín; Reus, Sergio; Álvarez, Nemesio; Bravo‐Ferrer, José María; Castelo, Laura; Cuenca, José; Llinares, Pedro; Rey, Enrique; Mayo, María Rodríguez; Sánchez, Efrén; Regueiro, Dolores Sousa; Martínez, Francisco Javier; Alonso, M.M.; Castro, Beatriz; Rosado, Dácil García; Durán, Ma del Carmen; Gómez, Ma Antonia Miguel; Lacalzada, Juan; Nassar, Ibrahim; Ciézar, Antonio Pláta; Iglesias, José Ma Reguera; Álvarez, Víctor Asensi; Costas, Carlos José; Hera, Jesús de la; Suárez, Jonnathan Fernández; Fraile, Lisardo Iglesias; Argüero, Víctor León; Menéndez, José López; Bajo, Pilar Mencia; Morales, Carlos; Torrico, Alfonso Moreno; Palomo, Carmen; Martínez, Begoña Paya; Esteban, Ángeles Rodríguez; García, Raquel Rodriguez; Asensio, Mauricio Telenti; Almela, Manuel; Ambrosioni, Juan; Azqueta, Manuel; Brunet, Mercè; Bodro, Marta; Cartañá, Ramón; Falces, Carlos; Fita, G.; Fuster, David; Mària, C. García de la; García‐Pares, Delia; Hernández‐Meneses, Marta; Pérez, Jaume Llopis; Marco, Francesc; Miró, José M.; Moreno, Asunción; Nicolás, David; Ninot, Salvador Pié i; Quintana, Eduard; Paré, Carlos; Pereda, Daniel; Pericàs, Juan M.; Pomar, José L.; Ramírez, José; Rovira, I.; Sandoval, Elena; Sitges, Marta; Soy, Dolors; Téllez, Adrián; Tolosana, José Marı́a; Vidal, Bárbara; Vilà, Jordi; Adán, Iván; Bermejo, Javier; Bouza, Emilio; Celemín, Daniel; Caballero, Gregorio Cuerpo; Delgado-Montero, Antonia; Mansilla, Ana García; Leoni, M.E. García; Ramallo, Víctor González; Hernández, Martha Kestler; Hualde, Amaia Marí; Marı́n, Mercedes; Martínez‐Sellés, Manuel; Muñóz, Patricia; Rincón, Cristina; Rodríguez‐Abella, Hugo; Rodríguez‐Créixems, Marta; Pinilla, Blanca; Pinto, Ángel González; Valerio, Maricela; Vázquez, Pilar; Moreno, Eduardo; Antorrena, Isabel; Loeches, Belén; Quirós, Alejandro Martín; Moreno, Mar; Ramírez, Ulises; Bastón, Verónica Rial; Romero, María; Saldaña, Araceli; Balbín, Jesús Agüero; Castillo, Carlos Armiñanzas; Arnáiz, Ana; Revillas, Francisco Arnáiz de las; Belaustegui, Manuel Cobo; Fariñas, María Carmen; Fariñas‐Álvarez, Concepción; Izquierdo, Rubén; García, Iván; Rico, Claudia González; Gutiérrez‐Cuadra, Manuel; Díez, José; Pajarón, Marcos; Parra, José Antonio; Teira, Ramón; Zarauza, Jesús; Parra, Jorge Calderón; Cobo, Marta; Domínguez, Fernándo; Fortaleza, Alberto; Pavía, Pablo García; González, Jesús; Cruz, Ana Fernández; Múñez, Elena; Ramos, António; Romero, Isabel Sánchez; Centella, Tomasa; Hermida, José Manuel; Moya, José Luís Medina; Martín‐Dávila, Pilar; Navas, Enrique; Oliva, Enrique; Río, Alejandro del; Stuart, Jorge Rodríguez‐Roda; Ruíz, Soledad; Tenorio, Carmen Hidalgo; Delia, Manuel Almendro; Araji, Omar; Barquero, José M.; Jambrina, Román Calvo; Cueto, Marina de; Gálvez-Acebal, Juan; Méndez, Irene; Morales, Isabel; López‐Cortés, Luis Eduardo; Alarcón, Arı́stides de; García, Emilio; Haro, Juan Luis; Lepe, José Antonio Suárez; López, Francisco Pérez; Luque, Rafael; Alonso, Luis Javier; Azcárate, P.; Gutiérrez, José; Blanco, José Ramón; Villegas, A. Cabrera; García‐Álvarez, Lara; Oteo, José Antonio; Sanz, Mercedes; Benito, Natividad de; Gurguí, Mercé; Pacho, Cristina; Pericàs, Juan M.; Pons, Guillem; Álvarez, M.; Fernández, A.; Martínez, Amparo; Prieto, A.; Regueiro, Benito; Tijeira, E.; Vega, Marino; Blasco, Andrés Canut; Mollar, José Cordo; Arana, Juan Carlos Gainzarain; Uriarte, Oscar García; López, Alejandro; Zárate, Zuriñe Ortiz de; Matos, José Antonio Urturi; Gloria, García-Domínguez; Sánchez-Porto, Antonio; Arribas-Leal, José María; Vázquez, Elisa García; Torres, Alicia Hernández; Blázquez, A Lozano; Valenzuela, Gonzalo de la Morena; Alonso, Ángel; Aramburu, Javier; Calvo, Felicitas Elena; Rodríguez, Anai Moreno; Tarabini‐Castellani, Paola; Gálvez, Eva; Bellido, C. Maicas; Pau, José Largo; Sepúlveda, Ma Antonia; Sierra, P.; Iqbal‐Mirza, Sadaf Zafar; Alcolea, Eva Cascales; Yáñez, I. Keituqwa; Martínez, Julián Navarro; Ballesta, Ana Peláez; Escobar, Eduardo Moreno; Monje, Alejandro Peña; Cabrera, Valme Sánchez; García, David Vinuesa; Asenjo, María Arrizabalaga; Luna, Carmen; Morcillo, Juana Núñez; Seco, Ma Cruz Pérez; Gelabert, Aroa Villoslada; Guallar, Carmen Aured; Abad, Nuria Fernández; Mangas, Pilar García; Adell, Marta Matamala; Ruiz, Ma Pilar Palacián; Porres, Juan Carlos; Vidal, Begoña Alcaraz; Trigueros, Nazaret Cobos; Espín, María Jesús Del Amor; Giner, José Antonio; Sánchez, Roberto Jiménez; Almazán, Amaya Jimeno; Freire, Alejandro Ortín; González, Monserrat Viqueira; Ramis, Pere Pericàs; Blanco, M; Bordes, Enrique Ruiz de Gopegui; Bonet, Laura Vidal; Munera, Ma Carmen Bellón; Garaizabal, Elena Escribano; Martínez, Antonia Tercero; Luque, Juan Carlos Segura; Badía, Cristina; Palop, Lucía Boix; Xercavins, Mariona; Ibars, Sònia; Nebreda, Eloy Gómez; Herrera, Ibalia Horcajada; Gallego, Irene Menduiña; Santiago, Hector; Martínez, Isabel de Miguel; Álamo, Elena Pisos; Pedroche, C Díaz; Cháves, Fernando; Cossío, Santiago de; Medrano, Francisco López; López, Ma Jesús; Solera, J; Solís, Jorge; Ardanuy, Carmen; Requena, Guillermo Cuervo; Grillo, Sara; Majoral, A. Ruiz

doi:10.1016/j.jacc.2019.11.047

Cited by 63 publications

(39 citation statements)

References 26 publications

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“…collected prospectively from 35 centers in Spain, recurrence was significantly higher in cases of infective endocarditis caused by Enterococcus spp. (3.5% vs. 1.7%) [28]. There were nine reported cases of E. hirae urinary tract infections with no recurrences or deaths.…”

Section: Discussionmentioning

confidence: 82%

Enterococcus hirae bacteremia associated with acute pyelonephritis in a patient with alcoholic cirrhosis: a case report and literature review

et al. 2021

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Background Infections caused by Enterococcus hirae are common in animals, with instances of transmission to humans being rare. Further, few cases have been reported in humans because of the difficulty in identifying the bacteria. Herein, we report a case of pyelonephritis caused by E. hirae bacteremia and conduct a literature review on E. hirae bacteremia. Case presentation A 57-year-old male patient with alcoholic cirrhosis and neurogenic bladder presented with fever and chills that had persisted for 3 days. Physical examination revealed tenderness of the right costovertebral angle. Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) of the patient’s blood and urine samples revealed the presence of E. hirae, and pyelonephritis was diagnosed. The patient was treated successfully with intravenous ampicillin followed by oral linezolid for a total of three weeks. Conclusion The literature review we conducted revealed that E. hirae bacteremia is frequently reported in urinary tract infections, biliary tract infections, and infective endocarditis and is more likely to occur in patients with diabetes, liver cirrhosis, and chronic kidney disease. However, mortality is not common because of the high antimicrobial susceptibility of E. hirae. With the advancements in MALDI-TOF MS, the number of reports of E. hirae infections has also increased, and clinicians need to consider E. hirae as a possible causative pathogen of urinary tract infections in patients with known risk factors.

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Section: Discussionmentioning

confidence: 82%

Enterococcus hirae bacteremia associated with acute pyelonephritis in a patient with alcoholic cirrhosis: a case report and literature review

et al. 2021

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“…The characteristics of the GAMES (Grupos de Apoyo para el Manejo de la Endocarditis en ESpaña) cohort, collection of data variables through a specific central registration depository (CRD), and general definitions are described elsewhere [ 12 , 13 ]. Sepsis and septic shock developing once patients were admitted to the hospital and occurring before cardiac surgery were prospectively collected in the GAMES CRD by physicians in charge of the Endocarditis Team in each collaborating center according to definitions by international consensus in place [ 14 ].…”

Section: Methodsmentioning

confidence: 99%

Outcomes and Risk Factors of Septic Shock in Patients With Infective Endocarditis: A Prospective Cohort Study

Pericàs

Hernández‐Meneses

Muñóz

et al. 2021

Open Forum Infectious Diseases

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Background Little is known about the characteristics and impact of septic shock (SS) on the outcomes of infective endocarditis (IE). We aimed to investigate the characteristics and outcomes of patients with IE presenting with SS and to compare them to those of IE patients with sepsis (Se) and those with neither Se nor SS (no-Se-SS). Methods Prospective cohort study of 4,864 IE patients from 35 Spanish centers (2008 to 2018). Logistic regression analyses were performed to identify risk factors for SS and mortality. Results SS and Se presented respectively in 597 (12.3%) and 559 (11.5%) patients. Patients with SS were younger and presented significantly higher rates of diabetes, chronic renal and liver disease, transplantation, nosocomial acquisition, S.aureus, IE complications, and in-hospital mortality (62.5%, 37.7% for Se and 18.2% for no-Se-SS,p<.001). S.aureus (OR 1.94, 95%CI 1.34-2.81,p<.001), Gram negative (OR 2.21,95%CI 1.25-3.91,p.006), nosocomial acquisition (OR 1.44,95%CI 1.07-1.94,p.015), persistent bacteremia (OR 1.82, 95%CI 1.24-2.68,p.002), acute renal failure (OR 3.02,95% 2.28-4.01,p<.001), CNS emboli (OR 1.48,1.08-2.01,p.013), and larger vegetation size (OR 1.01,95%CI 1.00-1.02,p.020) were associated with a higher risk of developing SS. Charlson score, heart failure, persistent bacteremia, acute renal failure, mechanical ventilation, worsening of liver disease, S.aureus and receiving aminoglycosides within the first 24h were associated with higher in-hospital mortality, whereas male sex, native valve IE and cardiac surgery were associated with lower mortality. Conclusions SS is frequent and entails dismal prognosis. Early identification of patients at risk of developing SS and early assessment for cardiac surgery appear as key factors to improve outcomes.

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“…Notably, while enterococci are also common residents of the oral cavity and an important cause of endodontic disease – and despite the persistent expectation that oral enterococci would turn out to be a common nidus for endocarditis – cohort analysis has not shown oral cavity infections to be common factors in IE. For example, in a recent large cohort Spanish study comparing enterococcal IE (516 patients) and non-enterococcal IE cases (3,308 patients), only 1.6% of enterococcal cases could be assigned an oral origin vs 6.7% of non-enterococcal cases ( Pericàs et al., 2020 ).…”

Section: Drivers Of E Faecalis Bacteremiamentioning

confidence: 99%

“…Over the past twenty years, enterococci have continued their emergence as important healthcare-associated pathogens. This development is likely multifactorial and has been driven, in part, by improved diagnostics, an aging population, increasingly invasive medical procedures, and further spread of antibiotic resistance ( Fernández-Hidalgo et al., 2020 ; Pericàs et al., 2020 ; Shah et al., 2020 ; Escolà-Vergé et al., 2021 ). The same time period also marked an explosion of research in the general field of bacterial biofilms ( Parsek and Fuqua, 2004 ; Haussler and Parsek, 2010 ; Haussler and Fuqua, 2013 ; Visick et al., 2016 ; Høiby, 2017 ; Fuqua et al., 2019 ), the publication of full genome sequences for E. faecalis V583 ( Paulsen et al., 2003 ), OG1RF ( Bourgogne et al., 2008 ), and dozens of other strains ( Palmer et al., 2010 ), as well as the development of improved tools for the genetic study of E. faecalis ( Kristich et al., 2005 ; Kristich et al., 2007 ; Kristich et al., 2008 ; Ballering et al., 2009 ).…”

Section: Introductionmentioning

confidence: 99%

Enterococcal Endocarditis: Hiding in Plain Sight

Barnes

Frank

Dunny

2021

Front. Cell. Infect. Microbiol.

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Enterococcus faecalis is a major opportunistic bacterial pathogen of increasing clinical relevance. A substantial body of experimental evidence suggests that early biofilm formation plays a critical role in these infections, as well as in colonization and persistence in the GI tract as a commensal member of the microbiome in most terrestrial animals. Animal models of experimental endocarditis generally involve inducing mechanical valve damage by cardiac catheterization prior to infection, and it has long been presumed that endocarditis vegetation formation resulting from bacterial attachment to the endocardial endothelium requires some pre-existing tissue damage. Here we review both historical and contemporary animal model studies demonstrating the robust ability of E. faecalis to directly attach and form stable microcolony biofilms encased within a bacterially-derived extracellular matrix on the undamaged endovascular endothelial surface. We also discuss the morphological similarities when these biofilms form on other host tissues, including when E. faecalis colonizes the GI epithelium as a commensal member of the normal vertebrate microbiome - hiding in plain sight where it can serve as a source for systemic infection via translocation. We propose that these phenotypes may allow the organism to persist as an undetected infection in asymptomatic individuals and thus provide an infectious reservoir for later clinical endocarditis.

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A Contemporary Picture of Enterococcal Endocarditis

Cited by 63 publications

References 26 publications

Enterococcus hirae bacteremia associated with acute pyelonephritis in a patient with alcoholic cirrhosis: a case report and literature review

Enterococcus hirae bacteremia associated with acute pyelonephritis in a patient with alcoholic cirrhosis: a case report and literature review

Outcomes and Risk Factors of Septic Shock in Patients With Infective Endocarditis: A Prospective Cohort Study

Enterococcal Endocarditis: Hiding in Plain Sight

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