Methods: We reviewed patients (pts) with NVS IE from 2007-16 using the Endocarditis Registry at the Cleveland Clinic, a referral center for cardiac surgery. The clinical diagnosis of IE was determined by modified Duke Criteria; etiology was established by microbiologic studies including 16s RNA bacterial sequencing of valve tissue.
Results: A total of 19 cases of IE due to NVS (1.4 % of all cases of IE) were identified. Seven pts (37%) had an infected prosthetic valve. The most commonly involved valve was mitral (74%) but both mitral and aortic valve infection was observed in 37%. The most common indication for surgery was valvular dysfunction (16 pts, 84%); 4 (21%) had peri-valvular abscesses and 3 (16%) had cardiogenic shock. Embolization occurred in 9 pts (47%), including 2 pts with stroke. Eighteen pts underwent valve replacement; one patient declined surgery. The mean interval between admission and valve surgery was 8 d (range: 2-22 d).
NVS grew in in blood cultures in 18 cases (95%); valve culture showed NVS in 2 cases (11%). All 12 specimens sent for valve sequencing, were PCR positive for NVS (6 Granulicatella sp. and 6 Abiotrophia sp.). Histopathologic examination of explanted valves demonstrated organisms on Gram staining in 13/18 cases (72%) and inflammation in 78%. The results of susceptibility testing were available for 8 NVS isolates; 63% were sensitive to penicillin (MIC ≤ 0.12 mcg/ml). Ceftriaxone was the most frequently prescribed antibiotic. The mean duration of antibiotic therapy was 5.8 wks (range: 3-8 wks) after valve surgery. Combination therapy with gentamicin was used in 36.8% (mean duration 8.4 d, range 1-14 d). Among 11 pts who had at least 6 months of follow up, no relapses were observed. The only patient who died within 30 days of admission did not undergo surgery. Median time of follow up after discharge was 29 months and no relapses were documented.
Conclusion: IE due to NVS accounts for about 2% of cases of IE at the Cleveland Clinic. All pts had surgical indications for valve replacement surgery and those who underwent surgery had no documented relapse and excellent long term survival.
G. Pettersson, None
J. Navia, None
S. Gordon, None
T. Fraser, None
S. J. Rehm, None