Abstract
Bacteremia is one of the most common manifestations of invasive pneumococcal disease (IPD). One complication of bacteremia is endocarditis; yet, few studies have evaluated the overall incidence and risk factors for IPD-associated endocarditis. Thus, we evaluated the overall incidence and risk factors of endocarditis compared to those without endocarditis in a large population of IPD patients. We prospectively collected all IPD cases from 2000 to 2014 in Northern Alberta, Canada. Descriptive statistics were used to compare sociodemographic variables, clinical characteristics, and IPD-related outcomes between patients with and without endocarditis. Endocarditis complicated the course of only 28 (0.3%) of 3251 adult patients with IPD. Endocarditis patients were more likely to use illicit drugs and have a higher severity of illness at presentation (i.e., higher rate of altered mental status and rate of intensive care unit [ICU] utilization, p < 0.05); however, no other major risk factors were identified. New murmur development among endocarditis patients was common: 39.3% compared to 2.2% of non-endocarditis patients (p < 0.001). The mortality rate of 39.3% was more than twice that of the rate of 14.7% for the patients with IPD but without endocarditis. There was no pneumococcal serotype predilection for endocarditis. Endocarditis is an uncommon complication of IPD, but, when present, is associated with a significantly increased risk of mortality. Overall, few specific risk factors were identified for IPD-related endocarditis, with the exception of illicit drug use.
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Acknowledgements
We wish to thank Ibrahim Quazi and Lilly Yusho for the data management and Carol Mangan RN for the data collection. We also thank the microbiology staff of the hospitals in Northern Alberta for forwarding Streptococcus pneumoniae isolates.
Funding
This study was supported by a grant-in-aid from Pfizer, Canada and Merck Canada Inc. The funders had no role in the design of the study or data analysis and they have not seen the manuscript. DTE is a Canada Research Chair supported by the Government of Canada. SRM holds the Endowed Chair in Patient Health Management from the Faculties of Medicine and Dentistry and Pharmacy and Pharmaceutical Sciences, University of Alberta.
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TJM and GJT designed the study, organized the data collection, and had full access to all of the data in the study. DTE conducted all analyses and had full access to the data. TJM, GJT, DTE, and SRM wrote the manuscript. All authors contributed to the interpretation of data, revised the manuscript for intellectual content, and approved the manuscript to be published.
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Other than the above two research grants, none for any author.
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Research Ethics Board University of Alberta (Pro00001314_REN8).
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Marrie, T.J., Tyrrell, G.J., Majumdar, S.R. et al. Risk factors for pneumococcal endocarditis. Eur J Clin Microbiol Infect Dis 37, 277–280 (2018). https://doi.org/10.1007/s10096-017-3128-z
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DOI: https://doi.org/10.1007/s10096-017-3128-z