1104. Who needs echocardiography for the diagnosis of infective endocarditis among non-pneumococcal streptococcal bacteremia patients?
Session: Poster Abstract Session: Clinical Infectious Diseases: Bacteremia and Endocarditis
Friday, October 28, 2016
Room: Poster Hall
Background:

We investigated initial clinical factors predicting the diagnosis of infective endocarditis demanding echocardiography among streptococcal bacteremia patients.

Methods:

Between January 2011, and December 2015, streptococcal bacteremia patients with echocardiography tests, from 2 tertiary teaching hospitals in South Korea, were included. Pneumococcal bacteremia was excluded. Through review of their electronic medical records and echocardiographic findings, factors of initial clinical manifestations predicting the diagnosis of infective endocarditis were analyzed. With the statistically meaningful factors from logistic regression analysis, a decision tree analysis was performed. The statistical analyses were performed using R statistics ver. 3.2.1.

Results:

During the study period, a total of 797 patients were presented with the streptococcal bacteremia; echocardiography was conducted to 205 patients. Forty six patients (46/797, 5.77%) were identified as infective endocarditis. Thirty (65.2%) patients had mitral valve endocarditis, and 18 (39.1%) had aortic valve endocarditis. Eight (18.6%) patients had a mechanical valve, and 3 (6.5%) had a splenic abscess, which were statistical significant (p<0.0001 and p=0.011). There were no statistical significances with the combined presence of liver abscess, osteomyelitis, and urinary tract infection and laboratory blood test results. Through multivariate logistic regression analysis, the predictive factors of infective endocarditis were age <60 years (OR, 5.23; 95% CI, 2.39-11.96), history of valvular heart disease (VHD) (OR, 7.51; 95% CI, 3.39-17.43), and complication of central nervous system (CNS) disease (OR, 3.10; 95% CI, 1.25-7.69). The age and history of VHD were shown as crucial decision factors in decision tree analysis.

Conclusion:

History of VHD, age <60 years, and complication of CNS disease at initial presentation were shown as significant risk factors predicting the diagnosis of streptococcal infective endocarditis. To identify the diagnosis of infective endocarditis, echocardiography should be actively conducted to the streptococcal bacteremia patients who have those risk factors.

Sang Ah Lee, MD1, Min Jung Kim, MD1, Shin-Woo Kim, MD, PhD1, Sook-in Jung, MD2, Seong Eun Kim, MD2, Uh Jin Kim, MD2 and Hyun-Ha Chang, MD1, (1)Kyungpook National University School of Medicine, Daegu, Korea, The Republic of, (2)Chonnam National University Medical School, Gwangju, Korea, The Republic of

Disclosures:

S. A. Lee, None

M. J. Kim, None

S. W. Kim, None

S. I. Jung, None

S. E. Kim, None

U. J. Kim, None

H. H. Chang, None

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