Table 1.
Comparison of the characteristics of the three groups of patients according to the localization of the infections: infective endocarditis and meningitis, infective endocarditis only, and community acquired meningitis only
| IE and meningitis (n = 42) | IE only (n = 482) | Pa | Meningitis only (n = 506) | Pb | Meningitis only excluding N. meningitidis (n = 395) | Pb | |
|---|---|---|---|---|---|---|---|
| Gender: male n (%) | 31 (73.8) | 359 (74.5) | 1.000 | 275 (54.3) | 0.015 | 214 (54.2) | 0.015 |
| Age (years) median [IQR] | 61.0 [54.1–71.8] | 64.8 [52.8–75.5] (n = 481) | 0.341 | 58.2 [40.3–68.5] (n = 500) | 0.055 | 61.0 [50.5–71.8] (n = 389) | 0.609 |
| Comorbidities | |||||||
| Diabetes mellitus | 9 (21.4) | 110 (22.8) | 1.000 | 71 (14.3) (n = 495) | 0.256 | 67 (17.4) (n = 384) | 0.526 |
| Coronary diseases | 4 (9.5) | 58 (12.0) | 0.805 | 21 (4.3) (n = 494) | 0.123 | 21 (5.5) (n = 384) | 0.293 |
| Chronic cardiac failure | 4 (9.5) | 76 (15.8) | 0.373 | 28 (5.6) (n = 497) | 0.301 | 28 (7.3) (n = 386) | 0.540 |
| Chronic renal failure | 5 (11.9) | 57 (11.8) | 1.000 | 20 (4.0) (n = 496) | 0.037 | 19 (4.9) (n = 386) | 0.074 |
| Neoplasia | 1 (2.4) | 88 (18.3) | 0.005 | 54 (10.8) (n = 498) | 0.108 | 49 (12.7) (n = 387) | 0.045 |
| Liver disease | 5 (11.9) | 67 (13.9) | 1.000 | 27 (5.4) (n = 496) | 0.094 | 26 (6.8) (n = 385) | 0.213 |
| Immunodeficiency (innate or acquired, including HIV) | 6 (14.3) | 33 (6.8) | 0.114 | 55 (11.0) (n = 499) | 0.455 | 49 (12.6) (n = 388) | 0.807 |
| Alcoholism | 10 (23.8) | 58 (12.6) (n = 461) | 0.056 | 74 (14.9) (n = 495) | 0.181 | 66 (17.2) (n = 384) | 0.291 |
| IV drug use | 2 (4.8) | 28 (5.8) | 1.000 | NA | NA | ||
| Hypertension | 17 (40.5) | 227 (47.1) | 0.426 | NA | NA | ||
| Cardiac condition predisposing to endocarditis | |||||||
| Any | 9 (21.4) | ||||||
| Pre-existing valvulopathy | 9 (21.4) | 174 (37.0) (n = 470) | 0.056 | NA | NA | ||
| Endocardial lead | 1 (2.4) | 65 (13.5) | 0.048 | NA | NA | ||
| Symptoms and signs on presentation | |||||||
| NYHA III/IV | 10 (33.3) (n = 30) | 97 (77.6) (n = 125) | < 0.001 | NA | NA | ||
| Time between symptom onset and hospitalization (days) | 2.0 [0.0–4.0] (n = 39) | 3.0 [0.0–10.0] (n = 294) | 0.065 | 1.0 [0.0–2.0] (n = 487) | 0.046 | 1.0 [0.0–2.0] (n = 376) | 0.059 |
| Time between symptom onset and hospitalization n (%) | (n = 488) | 0.001 | (n = 487) | 1.000 | (n = 376) | 1.000 | |
| After hospitalization | 1 (2.4) | 31 (6.5) | 13 (2.7) | 12 (3.2) | |||
| < 1 month | 41 (97.6) | 320 (66.7) | 471 (96.7) | 362 (96.3) | |||
| 1–3 months | 0 (0.0) | 81 (16.9) | 3 (0.6) | 2 (0.5) | |||
| > 3 months | 0 (0.0) | 40 (8.3) | 0 (0.0) | 0 (0.0) | |||
| Time between hospitalization and initiation of antibiotics(days) median [IQR] | 0.0 [0.0–1.0] | 2.0 [0.0–5.0] (n = 481) | < 0.001 | 0.0 [0.0–1.0] (n = 495) | 0.011 | 0.0 [0.0–1.0] (n = 385) | 0.053 |
| Fever | 36 (92.3) (n = 39) | 406 (89.4) (n = 454) | 0.785 | 342 (69.9) (n = 495) | 0.002 | 280 (73.5) (n = 381) | 0.010 |
| Glasgow coma scale, median [IQR] | 10.0 [9.0–13.0] (n = 29) | 15.0 [15.0–15.0] (n = 416) | < 0.001 | 10.0 [7.0–12.0] (n = 331) | 0.148 | 10.0 [8.0–12.0] (n = 285) | 0.162 |
| Biological tests on presentation | |||||||
| Blood white cells, median [IQR] | 15.2 [10.6–23.7] (n = 40) | 11.6 [7.8–14.9] (n = 467) | 0.001 | 15.4 [9.9–21.0] (n = 475) | 0.542 | 15.2 [9.9–20.4] (n = 365) | 0.423 |
| CRP, median [IQR] | 258.0 [108.0–360.0] (n = 35) | 103.7 [51.0–188.0] (n = 458) | < 0.001 | 181.5 [87.0–295.0] (n = 414) | 0.061 | 177.0 [78.0–301.0] (n = 319) | 0.056 |
| Microorganisms | (n = 456) | < 0.001 | (n = 493) | < 0.001 | (n = 493) | < 0.001 | |
| Streptococcaceae | 28 (66.6) | 232 (50.9) | |||||
| S. pneumoniae | 18 (42.9) | 0 (0.0) | 265 (53.8) | 265 (69.4) | |||
| S. pyogenes, Enterococcus, other streptococci (Pneumococcus excluded) | 5 (11.9) | 87 (19.1) | 23 (4.7) | 23 (6.0) | |||
| Oral streptococci | 4 (9.5) | 83 (18.2) | 7 (1.4) | 7 (1.8) | |||
| Group D streptococci | 1 (2.4) | 62 (13.6) | 2 (0.4) | 2 (0.5) | |||
| Staphylococci | 14 (33.3) | 173 (37.9) | |||||
| S. aureus | 14 (33.3) | 125 (27.4) | 4 (0.8) | 4 (1.0) | |||
| Coagulase-negative Staphylococcus | 0 (0.0) | 48 (10.5) | 0 (0.0) | 0 (0.0) | |||
| N. meningitidis | 0 (0.0) | 0 (0.0) | 111 (22.5) | 0 (0.0) | |||
| Othersc | 0 (0.0) | 51 (11.2) | 81 (16.4) | 81 (21.2) | |||
| ≥ 2 microorganisms | 0 (0.0) | 9 (1.9) | 1.000 | 0 (0.0) | 0 (0.0) | ||
| Infection origin | (n = 471) | 0.002 | |||||
| Community acquired | 40 (95.2) | 349 (74.1) | 506 (100%) | NA | 395 (100%) | NA | |
| Hospital acquired | 1 (2.4) | 109 (23.1) | 0 (0.0) | 0 (0.0) | |||
| Healthcare related but non-hospital acquired | 1 (2.4) | 13 (2.8) | 0 (0.0) | 0 (0.0) | |||
| IE characteristics | |||||||
| Location of IE | (n = 41) | < 0.001 | |||||
| Aortic valve | 13 (31.7%) | 94 (19.5%) | NA | NA | |||
| Mitral valve | 22 (53.7%) | 128 (26.6%) | NA | NA | |||
| Aortic & mitral valve | 2 (4.9%) | 143 (29.7%) | NA | NA | |||
| Tricuspid valve | 1 (2.4%) | 34 (7.1%) | NA | NA | |||
| Tricuspid & pulmonary | 0 (0.0%) | 1 (0.2%) | NA | NA | |||
| Bilateral IE | 3 (7.3%) | 59 (12.2%) | NA | NA | |||
| Endocardial lead | 0 (0.0%) | 14 (2.9%) | NA | NA | |||
| Other | 0 (0.0%) | 2 (0.4%) | NA | NA | |||
| Undetermined | 0 (0.0%) | 7 (1.5%) | NA | NA | |||
| Vegetation | 30 (71.4%) | 420 (87.1%) | 0.010 | NA | NA | ||
| Septic shock | 20 (48.8) (n = 41) | 77 (16.0) | < 0.001 | NA | NA | ||
| Left ventricular ejection fraction < 45% | 3 (7.7) (n = 39) | 49 (11.8) (n = 416) | 0.602 | NA | NA | ||
| Cardiac abscess | 7 (16.7%) | 79 (16.4%) | 1.000 | NA | NA | ||
| Prosthesis dehiscence | 0 (0.0%) (n = 29) | 20 (19.6%) (n = 102) | 0.007 | NA | NA | ||
| Severe regurgitation | 24 (58.5%) (n = 41) | 186 (46.4%) (n = 401) | 0.144 | NA | NA | ||
| Cerebrovascular complications, (a)symptomatic | 21 (50.0) | 123 (25.5) | 0.002 | 128 (25.3) | 0.001 | 111 (28.1) | 0.005 |
| Valvular surgery | |||||||
| Rate | 18 (42.9%) | 227 (47.1%) | 0.632 | NA | NA | ||
| Time between surgery and hospitalization or diagnosis, median [IQR] | 10.5 [2.0–19.0] | 8.0 [2.0–22.0] | 0.923 | NA | NA | ||
| In-hospital outcome | |||||||
| Mortality at 30 days | 9 (21.4) | 64 (13.3) | 0.161 | 69 (13.6) | 0.169 | 64 (16.2) | 0.386 |
| Mortality at 3 months | 12 (28.6) | 99 (20.5) | 0.238 | 84 (16.6) | 0.058 | 79 (20.0) | 0.229 |
| Time between hospitalization and death, median [IQR] | 23.0 [15.0–31.0] (n = 13) | 27.0 [12.0–51.0] (n = 113) | 0.463 | 10.0 [2.0–39.0] (n = 97) | 0.134 | 11.0 [2.5–44.5] (n = 92) | 0.200 |
| Length of stay for survivors, median [IQR] | 47.0 [30.0–58.0] (n = 30) | 43.0 [27.0–66.0] (n = 481) | 0.857 | 16.0 [11.0–29.0] (n = 359) | < 0.001 | 18.0 [14.0–34.0] (n = 259) | < 0.001 |
| Length of stay, median [IQR] | 44.0 [21.0–58.0] (n = 35) | 46.0 [29.0–71.0] (n = 481) | 0.228 | 15.0 [9.0–28.0] (n = 445) | < 0.001 | 17.0 [11.0–32.0] (n = 340) | < 0.001 |
We also performed the analysis for meningitis only after withdrawal of meningitis due to Neisseria meningitis
The causative microorganisms in the patients with IE–BM from the AEPEI IE cohort were Streptococcaceae (8, out of 240, 3.3%) (3 S. pneumoniae, 1 Streptococcus dysgalactiae subsp. equisimilis, 1 Enterococcus faecalis, 1 Streptococcus oralis, 1 Streptococcus anginosus, 1 Streptococcus pyogenes), and S. aureus (7, out of 180, 3.9%) (only 1 MRSA). One patient had both a S. aureus and Streptococcus infantarius
Procedure or situations entailing risk of bacteremia were specific to the AEPEI cohort. They were actively searched among the 27 patients from the COMBAT meningitis cohort but not for the patients with BM only, therefore identified in the comparison with NA. (Procedures entailing risk were dental procedures, gastrointestinal or urogenital procedures, respiratory tract procedures, skin and soft tissue procedures, cardiac catheterization. Situations entailing risk were prolonged central venous access, active intravenous drug abuse, skin and soft tissue lesion)
NA non-applicable/non-available
aComparison of the patients with IE-BM to the IE population
bComparison of the patients with IE–BM to the meningitis population
cOthers included Listeria monocytogenes + Haemophilus influenzae + E. coli + Mycobacterium tuberculosis + Others + ≥ 2 microorganisms