A Contemporary Picture of Enterococcal Endocarditis

J Am Coll Cardiol. 2020 Feb 11;75(5):482-494. doi: 10.1016/j.jacc.2019.11.047.


Background: Enterococcal endocarditis (EE) is a growing entity in Western countries. However, quality data from large studies is lacking.

Objectives: The purpose of this study was to describe the characteristics and analyze the prognostic factors of EE in the GAMES cohort.

Methods: This was a post hoc analysis of a prospectively collected cohort of patients from 35 Spanish centers from 2008 to 2016. Characteristics and outcomes of 516 cases of EE were compared with those of 3,308 cases of nonenterococcal endocarditis (NEE). Logistic regression and Cox proportional hazards regression analysis were performed to investigate risk factors for in-hospital and 1-year mortality, as well as relapses.

Results: Patients with EE were significantly older; more frequently presented chronic lung disease, chronic heart failure, prior endocarditis, and degenerative valve disease; and had higher median age-adjusted Charlson score. EE more frequently involved the aortic valve and prosthesis (64.3% vs. 46.7%; p < 0.001; and 35.9% vs. 28.9%; p = 0.002, respectively) but less frequently pacemakers/defibrillators (1.5% vs. 10.5%; p < 0.001), and showed higher rates of acute heart failure (45% vs. 38.3%; p = 0.005). Cardiac surgery was less frequently performed in EE (40.7% vs. 45.9%; p = 0.024). No differences in in-hospital and 1-year mortality were found, whereas relapses were significantly higher in EE (3.5% vs. 1.7%; p = 0.035). Increasing Charlson score, LogEuroSCORE, acute heart failure, septic shock, and paravalvular complications were risk factors for mortality, whereas prior endocarditis was protective and persistent bacteremia constituted the sole risk factor for relapse.

Conclusions: Besides other baseline and clinical differences, EE more frequently affects prosthetic valves and less frequently pacemakers/defibrillators. EE presents higher rates of relapse than NEE.

Trial registration: ClinicalTrials.gov NCT00871104.

Keywords: enterococci; epidemiology; heart failure; infective endocarditis; prosthetic valves; relapses.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cohort Studies
  • Endocarditis, Bacterial / epidemiology*
  • Endocarditis, Bacterial / microbiology
  • Enterococcus faecalis / isolation & purification*
  • Female
  • Gram-Positive Bacterial Infections / epidemiology*
  • Gram-Positive Bacterial Infections / microbiology
  • Humans
  • Male
  • Middle Aged
  • Spain / epidemiology

Associated data

  • ClinicalTrials.gov/NCT00871104