Relationship Between Enterococcus faecalis Infective Endocarditis and Colorectal Neoplasm: Preliminary Results From a Cohort of 154 Patients

Rev Esp Cardiol (Engl Ed). 2017 Jun;70(6):451-458. doi: 10.1016/j.rec.2016.10.013. Epub 2017 Mar 9.
[Article in English, Spanish]


Introduction and objectives: The association between Streptococcus bovis group infective endocarditis and colorectal neoplasm (CRN) is well-known. However, no studies have assessed the association between Enterococcus faecalis infective endocarditis (EFIE) and CRN. We aimed to determine whether the prevalence of CRN is higher in patients with EFIE and an unclear source of infection than in patients with EFIE and a known source of infection or in the general population.

Methods: Retrospective analysis of a cohort of 154 patients with definite EFIE (109 with an unclear source of infection and 45 with an identified source) from 2 Spanish teaching hospitals to determine the prevalence of CRN and other colorectal diseases.

Results: In the group with an unknown source of infection, 61 patients (56%) underwent colonoscopy; of these, 31 (50.8%) had CRN. Nonadvanced colorectal adenoma was detected in 22 patients (36%), advanced adenoma in 5 (8.2%), and colorectal carcinoma (CRC) in 4 (6.6%). Among patients who survived the EFIE episode with ≥ 2 years of follow-up, 1 case of CRC was subsequently diagnosed. Only 6 patients (13.3%) with an identified focus of infection underwent colonoscopy; 1 of these patients (16.7%) was diagnosed with CRN. The prevalence of adenomas was slightly higher than that of the Spanish population in the same age range, whereas that of CRC was 17-fold higher.

Conclusions: CRN was found in more than half of patients with EFIE and an unclear focus of infection who underwent colonoscopy. Colonoscopy should be recommended in patients with EFIE and an unclear source of infection.

Keywords: Colonoscopia; Colonoscopy; Colorectal cancer; Colorectal disease; Cáncer colorrectal; Endocarditis; Enfermedad colorrectal; Enterococcus faecalis; Epidemiology; Epidemiología.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Colonoscopy
  • Colorectal Neoplasms / diagnosis
  • Colorectal Neoplasms / epidemiology
  • Colorectal Neoplasms / etiology*
  • Endocarditis, Bacterial / complications*
  • Endocarditis, Bacterial / microbiology
  • Enterococcus faecalis / isolation & purification*
  • Female
  • Follow-Up Studies
  • Gram-Positive Bacterial Infections / complications*
  • Gram-Positive Bacterial Infections / microbiology
  • Humans
  • Male
  • Middle Aged
  • Prevalence
  • Retrospective Studies
  • Spain / epidemiology