Table 2.
Comparison of the characteristics of the three groups of patients with streptococci or staphylococci infections according to the localization of the infections: infective endocarditis and meningitis, infective endocarditis only, and community acquired meningitis only
| Streptococci | Staphylococci | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| IE + meningitis (n = 28) | IE only (n = 232) | Pa | Meningitis only (n = 297) | Pb | IE + meningitis (n = 14) | IE only (n = 125) | Pa | Meningitis only (n = 4) | Pb | |
| Gender: male n (%) | 21 (75.0) | 180 (77.6) | 0.812 | 159 (53.5) | 0.030 | 10 (71.4) | 89 (71.2) | 1.000 | 2 (50.0) | 0.569 |
| Age (years) median [IQR] | 61.0 [53.3–71.2] | 65.4 [53.9–76.2] | 0.214 | 60.6 [50.0–71.2] (n = 293) | 0.596 | 64.1 [54.1–71.8] | 62.9 [44.5–75.6] | 0.992 | 62.7 [40.1–72.0] | 0.873 |
| Comorbidities | ||||||||||
| Diabetes mellitus | 6 (21.4) | 44 (19.0) | 0.800 | 50 (17.3) (n = 289) | 0.604 | 3 (21.4) | 30 (24.0) | 1.000 | 1 (25.0) | 1.000 |
| Coronary diseases | 4 (14.3) | 21 (9.1) | 0.325 | 19 (6.6) (n = 289) | 0.133 | 0 (0.0) | 16 (12.8) | 0.370 | 0 (0.0) | |
| Chronic cardiac failure | 3 (10.7) | 25 (10.8) | 1.000 | 20 (6.9) (n = 291) | 0.439 | 1 (7.1) | 24 (19.2) | 0.465 | 1 (25.0) | 0.405 |
| Chronic renal failure | 3 (10.7) | 18 (7.8) | 0.482 | 13 (4.5) (n = 291) | 0.156 | 2 (14.3) | 19 (15.2) | 1.000 | 0 (0.0) | 1.000 |
| Neoplasia | 1 (3.6) | 51 (22.0) | 0.022 | 35 (12.0) (n = 292) | 0.341 | 0 (0.0) | 15 (12.0) | 0.363 | 0 (0.0) | |
| Liver disease | 4 (14.3) | 27 (11.6) | 0.756 | 16 (5.5) (n = 290) | 0.087 | 1 (7.1) | 23 (18.4) | 0.464 | 0 (0.0) | 1.000 |
| Immunodeficiency (innate or acquired, including HIV) | 4 (14.3) | 15 (6.5) | 0.133 | 39 (13.3) (n = 293) | 0.777 | 2 (14.3) | 7 (5.6) | 0.225 | 1 (25.0) | 1.000 |
| Alcoholism | 9 (32.1) | 29 (12.9) (n = 224) | 0.020 | 46 (15.9) (n = 289) | 0.038 | 1 (7.1) | 20 (17.5) (n = 114) | 0.464 | 0 (0.0) | 1.000 |
| IV drug use | 1 (3.6) | 3 (1.3) | 0.369 | 1 (7.1) | 21 (16.8) | 0.698 | ||||
| Hypertension | 12 (42.9) | 114 (49.1) | 0.555 | 5 (35.7) | 54 (43.2) | 0.777 | ||||
| Cardiac condition predisposing to endocarditis | ||||||||||
| Any | 6 (21.4) | 3 (21.4) | ||||||||
| Pre-existing valvulopathy | 6 (21.4) | 89 (39.6) (n = 225) | 0.079 | 3 (21.4) | 36 (29.3) (n = 123) | 0.757 | ||||
| Endocardial lead | 1 (3.6) | 7 (3.0) | 0.603 | 0 (0.0) | 19 (15.2) | 0.216 | ||||
| Symptoms and signs on presentation | ||||||||||
| NYHA III/IV | 7 (31.8) (n = 22) | 50 (78.1) (n = 64) | < 0.001 | 3 (37.5) (n = 8) | 22 (81.5) (n = 27) | 0.027 | ||||
| Time between symptom onset and hospitalization in days | 1.5 [0.0–3.0] (n = 26) | 6.0 [1.0–19.0] (n = 126) | 0.001 | 1.0 [0.0–2.0] (n = 284) | 0.157 | 2.0 [0.0–4.0] (n = 13) | 2.0 [0.0–6.0] (n = 97) | 0.940 | 3.0 [2.0–4.5] | 0.954 |
| Time between symptom onset and hospitalization n (%) | (n = 28) | 0.002 | (n = 284) | 1.000 | (n = 124) | 0.874 | 0.405 | |||
| After hospitalization | 0 (0.0) | 8 (3.4) | 8 (2.8) | 1 (7.1) | 11 (8.9) | 1 (25.0) | ||||
| < 1 month | 28 (100.0) | 140 (60.3) | 274 (96.5) | 13 (92.9) | 102 (82.3) | 3 (75.0) | ||||
| 1–3 months | 0 (0.0) | 59 (25.4) | 2 (0.7) | 0 (0.0) | 9 (7.3) | 0 (0.0) | ||||
| > 3 months | 0 (0.0) | 23 (9.9) | 0 (0.0) | 0 (0.0) | 2 (1.6) | 0 (0.0) | ||||
| Time between hospitalization and initiation of antibiotics (days) median [IQR] | 0.0 [0.0–1.0] | 2.0 [0.0–3.0] | < 0.001 | 0.0 [0.0–1.0] (n = 290) | 0.044 | 0.5 [0.0–1.0] | 1.0 [0.0–4.0] | 0.039 | 1.5 [0.5–3.0] | 0.151 |
| Fever | 25 (96.2) (n = 26) | 195 (91.1) (n = 214) | 0.706 | 209 (73.3) (n = 285) | 0.008 | 11 (84.6) (n = 13) | 118 (96.7) (n = 122) | 0.103 | 4 (100.0) | 1.000 |
| Glasgow coma scale, median [IQR] | 10.0 [8.0–13.0] (n = 19) | 15.0 [15.0–15.0] (n = 203) | < 0.001 | 10.0 [7.0–12.0] (n = 227) | 0.581 | 12.5 [10.0–14.0] (n = 10) | 15.0 [14.0–15.0] (n = 105) | < 0.001 | 12.5 [12.0–13.0] (n = 2) | 1.000 |
| Biological tests on presentation | ||||||||||
| Blood white cells, median [IQR] | 20.6 [10.5–26.7] (n = 27) | 10.9 [7.6–14.8] (n = 225) | 0.005 | 15.4 [10.3–21.4] (n = 278) | 0.315 | 15.0 [12.0–16.5] (n = 13) | 13.0 [8.9–16.6] (n = 121) | 0.336 | 17.0 [12.9–20.8] (n = 3) | 0.420 |
| CRP, median [IQR] | 216.5 [100.0–306.0] (n = 22) | 93.0 [54.5–142.5] (n = 224) | < 0.001 | 187.5 [91.0–318.0] (n = 238) | 0.793 | 300.0 [250.0–401.0] (n = 13) | 212.0 [121.0–293.0] (n = 113) | 0.013 | 303.0 [221.0–334.0] | 0.610 |
| Microorganisms | < 0.001 | < 0.001 | 1.000 | 1.000 | ||||||
| Streptococci | ||||||||||
| S. pneumoniaec | 18 (64.3) | 0 (0.0) | 265 (89.2) | NA | NA | NA | NA | |||
| S. pyogenes + Enterococcus + other streptococci (Pneumococcus excluded) | 5 (17.9) | 87 (37.5) | 23 (7.7) | NA | NA | NA | NA | |||
| Oral streptococci | 4 (14.3) | 83 (35.8) | 7 (2.4) | NA | NA | NA | NA | |||
| Group D streptococci | 1 (3.6) | 62 (26.7) | 2 (0.7) | NA | NA | NA | NA | |||
| Staphylococci | ||||||||||
| S. aureus | NA | NA | NA | NA | 14 (100.0) | 125 (100.0) | 4 (100.0) | |||
| ≥ 2 microorganisms | 0 (0.0) | 0 (0.0) | 1.000 | 0 (0.0) | 1.000 | 0 (0.0) | 0 (0.0) | 1.000 | 0 (0.0) | 1.000 |
| Infection origin | (n = 224) | 0.306 | (n = 124) | 0.156 | ||||||
| Community | 27 (96.4) | 202 (90.2) | 13 (92.9) | 84 (67.7) | ||||||
| Hospital acquired | 0 (0.0) | 16 (7.1) | 1 (7.1) | 37 (29.8) | ||||||
| Non hospital acquired | 1 (3.6) | 6 (2.7) | 0 (0.0) | 3 (2.4) | ||||||
| IE characteristics | ||||||||||
| Location of IE | 0.002 | (n = 13) | 0.437 | |||||||
| Aortic valve | 9 (32.1) | 47 (20.3) | 4 (30.8) | 23 (18.4) | ||||||
| Mitral valve | 15 (53.6) | 64 (27.6) | 7 (53.8) | 37 (29.6) | ||||||
| Aortic & mitral valves | 1 (3.6) | 86 (37.1) | 1 (7.7) | 28 (22.4) | ||||||
| Tricuspid valve | 1 (3.6) | 4 (1.7) | 0 (0.0) | 16 (12.8) | ||||||
| Tricuspid & pulmonary valve | 0 (0.0) | 1 (0.8) | ||||||||
| Bilateral valves | 2 (7.1) | 26 (11.2) | 1 (7.7) | 16 (12.8) | ||||||
| Endocardial lead | 0 (0.0) | 3 (2.4) | ||||||||
| Other | 0 (0.0) | 2 (0.9) | 0 (0.0) | 1 (0.8) | ||||||
| Undetermined | 0 (0.0) | 3 (1.3) | 4 (30.8) | 23 (18.4) | ||||||
| Vegetation | 19 (67.9) | 203 (87.5) | 0.010 | 11 (78.6) | 111 (88.8) | 0.380 | ||||
| Septic shock | 12 (44.4) (n = 27) | 19 (8.2) | < 0.001 | 8 (57.1) | 43 (34.4) | 0.142 | ||||
| FeVG < 45% | 2 (7.4) (n = 27) | 18 (8.7) (n = 206) | 1.000 | 1 (8.3) (n = 12) | 16 (15.5) (n = 103) | 1.000 | ||||
| Cardiac abscess | 6 (21.4) | 36 (15.5) | 0.418 | 1 (7.1) | 21 (16.8) | 0.698 | ||||
| Prosthesis dehiscence | 0 (0.0) (n = 22) | 8 (20.5) (n = 39) | 0.042 | 0 (0.0) (n = 7) | 3 (13.6) (n = 22) | 0.558 | ||||
| Severe regurgitation | 19 (67.9) | 106 (49.5) (n = 214) | 0.074 | 5 (38.5) (n = 13) | 36 (37.1) (n = 97) | 1.000 | ||||
| Cerebrovascular complications, symptomatic or not | 13 (46.4) | 59 (25.4) | 0.025 | 89 (30.0) | 0.088 | 8 (57.1) | 40 (32.0) | 0.077 | 1 (25.0) | 0.577 |
| Valvular surgery | ||||||||||
| Rate | 12 (42.9) | 117 (50.4) | 0.549 | 6 (42.9) | 43 (34.4) | 0.563 | ||||
| Time between surgery and hospitalization or diagnosis, median [IQR] | 14.5 [6.0–25.0] | 7.0 [2.0–24.0] | 0.296 | 1.5 [1.0–13.0] | 8.0 [2.0–16.0] | 0.221 | ||||
| In-hospital outcome | ||||||||||
| Mortality, 30 days | 5 (17.9) | 19 (8.2) | 0.155 | 54 (18.2) | 1.000 | 4 (28.6) | 31 (24.8) | 0.751 | 0 (0.0) | 0.524 |
| Mortality, 3 months | 6 (21.4) | 33 (14.2) | 0.397 | 64 (21.5) | 1.000 | 6 (42.9) | 45 (36.0) | 0.771 | 0 (0.0) | 0.245 |
| Delay between hospitalization and death, median [IQ R] | 26.0 [18.0–37.0] | 31.0 [12.0–60.0] | 0.891 | 9.0 [2.0–32.0] | 0.035 | 12.0 [4.0–31.0] | 23.5 [11.0–42.0] | 0.203 | – | – |
| Length of stay for survivors, median [IQR] | 44.0 [30.0–57.0] | 42.0 [27.0–59.5] | 0.887 | 17.0 [14.0–30.5] | < 0.001 | 53.0 [26.0–65.0] | 40.0 [25.0–67.0] | 0.649 | 23.0 [7.0–63.0] | 0.483 |
| Length of stay, median [IQR] | 35.0 [23.0–57.0] (n = 22) | 45.0 [30.0–68.0] (n = 232) | 0.212 | 16.0 [11.0–28.0] (n = 262) | < 0.001 | 53.0 [17.0–60.0] (n = 13) | 40.0 [25.0–72.0] | 0.838 | 23.0 [7.0–63.0] (n = 3) | 0.736 |
aComparison of the patients with IE-BM to the IE population
bComparison of the patients with IE-BM to the meningitis population
cDexamethasone use was reported only in 8/18 patients with IE–BM with S. pneumoniae