High Prevalence of Infective Endocarditis in E faecalis Bacteremia

blockage of the right pulmonary artery in a case of bacterial endocarditis
blockage of the right pulmonary artery in a case of bacterial endocarditis

Data published in the Journal of the American College of Cardiology showed a high prevalence of definite infective endocarditis (IE) in patients with Enterococcus faecalis bacteremia (26%), suggesting that echocardiography should be considered in patients with E faecalis infection.

A multicenter study using echocardiography was conducted from January 2014 to December 2016 in 344 consecutive patients with E faecalis bacteremia. Patients were examined using echocardiography, including transesophageal echocardiography in 74% of cases.

The mean age of patients was 74.2 years, and 73.5% were men. The prevalence of definite endocarditis was 26.1%±4.6%, which accounted for 90 of the 344 included patients. Identified risk factors for IE included prosthetic heart valve (odds ratio [OR], 3.93; 95% CI, 1.76-8.77; P =.001), community acquisition (OR, 3.35; 95% CI, 1.74-6.46; P <.001), ≥3 positive blood culture bottles (OR, 3.69; 95% CI, 1.88-7.23; P <.001), unknown portal of entry (OR, 2.36; 95% CI, 1.26-4.40; P =.007), monomicrobial bacteremia (OR, 2.73; 95% CI, 1.23-6.05; P =.013), and immunosuppression (OR, 2.82; 95% CI, 1.20-6.58; P =.017).

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The study was performed in a single region of Scandinavia, and therefore the findings are limited in their generalizability beyond this region, as the properties of E faecalis strains are likely related to geography. The investigators also noted that the study would have benefited from systematic control blood cultures in all patients during and after treatment, which would have allowed a more thorough investigation for continuous and relapse bacteremia to be completed.

On the basis of these results showing a high prevalence of IE in patients with E faecalis bacteremia, the investigators recommended an increase in the use of echocardiography in patients with this type of bacteremia.


Dahl A, Iversen K, Tonder N, et al. Prevalence of infective endocarditis in Enterococcus faecalis bacteremia. J Am Coll Cardiol. 2019;74:193-201.