858. Beta Hemolytic Streptococcus Infective Endocarditis: Factors Associated with Early Mortality
Session: Poster Abstract Session: Bacteremia and Endocarditis
Friday, October 9, 2015
Room: Poster Hall
Posters
  • BHS IE.pdf (276.3 kB)
  • Background:

    Infective endocarditis (IE) due to beta-hemolytic streptococci (BHS) is recognized for its high complication rate, aggressive valvular destruction, and high mortality. We investigated for clinical risk factors related to mortality and impact of surgery on long-term survival.

    Methods:

    We reviewed all patients ≥18 years old diagnosed with BHS IE at Mayo Clinic from January 1, 2000, to December 31, 2014. Cases were identified through the Mayo Clinic Infectious Diseases registry. Univariate analysis was performed to analyze clinical features associated with 30-day mortality. A propensity score analysis including factors from (table) was used to evaluate the effect of 30-day surgery on subsequent mortality in 30-day survivors.

    Results:

    Forty-nine definite cases of BHS IE were identified. Mean (±SD) age was 64 (±14.9) years and 65% were males. The median^ (IQR) time to diagnosis from symptom onset was 6 days (5, 10). Associated risk factors included the presence of a prosthetic valve (41%), malignancy (33%), and diabetes mellitus (DM) (31%). DM patients were more likely to have ≥ 1cm vegetations (80%) vs non-DM (35%); (p=0.004).

    All cause one month and 6-month mortality were 25% and 31%, respectively. Factors associated with 30-day mortality were ≥ 1cm vegetation and higher score of Charlson comorbidity index (CCI). Thirty-six patients survived the first thirty days, of whom 18 (50%) underwent surgery within one month. Surgically- treated patients did not have improved survival in the propensity score adjusted model (HR=1.50; 95% CI, 0.30- 7.55; P= 0.625)

    Table: Characteristics According to 30-Day Mortality Status

    Variable

    30-Day Mortality
    (n=12)

    No 30-Day Mortality
    (n=36)

    P-value

    Age at Diagnosis

    66.5±15.0

    63.4±15.2

    0.543

    Male Gender

    10 (83%)

    21 (58%)

    0.117

    Charlson Comorbidity Index^

    3.5 (2.5, 4.5)

    1.0 (0.0, 2.5)

    0.001

    Septic Emboli, Brain

    7 (58%)

    14 (39%)

    0.240

    Prosthetic valve

    6 (50%)

    14 (39%)

    0.499

    Valvular Insufficiency

    5 (42%)

    19 (53%)

    0.505

    Intracardiac abscess

    3 (25%)

    9 (25%)

    1.000

    Vegitation size >1cm

    10 (83%)

    14 (39%)

    0.008

    Conclusion:

    BHS IE has high morbidity and mortality. Mortality is highest within 30 days from diagnosis, and was significantly associated with high CCI and vegetation size ≥1cm; which were more likely to occur in DM patients.  Among patient who survived the first 30 days, there was no statistical benefit of valve surgery on long-term survival.

    Abdelghani El Rafei, MD1, Daniel Desimone, MD1, Christopher Desimone, MD, PHD2, Brian Lahr, MS3, James Steckelberg, MD, FIDSA1, Muhammad R. Sohail, MD, FIDSA1, Walter R. Wilson, MD, FIDSA1 and Larry Baddour, MD, FIDSA1, (1)Infectious Disease, Mayo Clinic, College of Medicine, Rochester, MN, (2)Cardiovascular, Mayo Clinic, College of Medicine, Rochester, MN, (3)Biomedical Statistics and Informatics, Mayo Clinic, College of Medicine, Rochester, MN

    Disclosures:

    A. El Rafei, None

    D. Desimone, None

    C. Desimone, None

    B. Lahr, None

    J. Steckelberg, None

    M. R. Sohail, Tyrex: Consultant , Research support

    W. R. Wilson, None

    L. Baddour, None

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