Document Type : Original Article

Authors

1 Assistant professor of infectious disease ,Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran

2 Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran

3 Associate professor of sports and exercise medicine, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran

4 Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran

5 Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran

6 Assistant professor of cardiology, Fellowship in echocardiography, Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran

Abstract

Background:Enterococci are responsible for 5% to 18% of infective endocarditis (IE) cases.We aimed to determine demographic data,predisposing factors,clinical presentations,complications,and echocardiographic findings concerning enterococcal endocarditis.Methods: Since 2006,all adult patients with a possible or definite diagnosis of IE based on the modified Duke criteria have been enrolled in the Iranian Registry of Infective Endocarditis.In this study,patients with IE of enterococcal origin were detected and their demographic characteristics,predisposing factors,complications, laboratory data,and echocardiographic findings were assessed.Results:Out of 731 patients diagnosed with endocarditis according to the modified Duke criteria, enterococci were found in 60 patients: 32 men(53.3%)and 28 women(46.7%)at a mean age of 55.21 years.Definite IE was diagnosed in 57(95%) patients, and possible IE was suspected in 3 patients(5%).The most frequent predisposing factor was the prosthetic valve(n=28, 46.7%),followed by a history of previous endocarditis (n=12, 20%).An acute course(<6 wk) was reported in 38 patients (63.3%).Fever (n=58, 95%)and loss of appetite (n=17, 28.3%)were the most frequent symptoms.Left-sided IE was more common than right-sided IE.The most frequent location of involvement was the aortic valve (n=22, 36.7%),followed by the mitral valve(n=20, 33.3%). Vegetation was detected in 53 patients (88.3%),abscess formation in 8 (13%), pseudoaneurysms in 3 (5%),and fistulae in 2 (3.3%).Fifteen patients (25%)had heart failure,and 11(18%)had central nervous system complications.The mortality rate was 20%.Conclusions: Given the serious complications and the high mortality rate in patients with IE of enterococcal origin,which may be due to these organisms’ intrinsic resistance to many antibiotics,we suggest further studies to determine more effective antibiotic regimens and even individualized antibiotic therapies for enterococcal endocarditis.

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