689. Streptococcus suis Endocarditis: Echocardiographic Features and Clinical Outcomes

Abstract Background Streptococcus suis (S. suis) is a zoonotic pathogen that transmits to the human with direct contact of pig or raw pork ingestion. This infection has been described in Asia, especially Thailand, Vietnam, and China. S. suis could cause wide range of infection, including endocarditis. This study aimed to describe the clinical features, echocardiogram findings, and outcomes of S. suis endocarditis. Methods A single center, ten-year (January 2009 to December 2018), retrospective cohort was conducted among patients who were diagnosed with S.suis endocarditis in 1,200-bed hospital in Northern, Thailand. Results Forty-three patients of S.suis endocarditis were identified during the study period. Of those, 28 (65%) patients had positive blood culture and 15 (35%) was diagnosed by 16SRNA bacterial identification from heart valve tissue. Majority (81%) were male with median age of 35. There were 62 affected valves in 43 patients. Twenty patients (48%) had vegetation larger than 10 mm in diameter and 35 (81.4%) patients had moderately severe or severe valvular regurgitation. Valvular perforation was described in 23 patients (53%). Perivalvular complications were founded in 15 patients (35%). Systemic embolism occurred in 17 (40%) patients. Cardiac operation was undertaken in 35 (81%) patients. There were 2 in-hospital deaths (5%) and 6 patients (14%) had disabilities. Moderately severe/severe regurgitation, systemic embolism, and no cardiac operation were significantly associated with disability or death from univariate analysis. By logistic regression analysis, systemic embolism was the only risk factor for disability or death (OR = 12.6, 95% CI 1.3-123.5, p = 0.029). Presenting signs/symptoms, prediction score and laboratory data on admission Conclusion S. suis endocarditis had high rate of valvular damage with complications and resulting systemic embolism. Surgery is required in majority of the patients. Embolism was associated with disability or death. Disclosures All Authors: No reported disclosures


Session: P-32. Endocarditis
Background. Transcatheter aortic valve replacement (TAVR) is increasingly used for lower risk patients. Incidence of TAVR endocarditis ranges from 0.2% to 3.3%. The purpose of this study was to determine local incidence and risk factors of prosthetic valve infective endocarditis (PVIE) in a contemporary cohort.
Methods. IRB approved retrospective, nested case-control study evaluated the 1-year incidence and risk factors for PVIE among TAVR recipients from 2015 to 2019. Inclusion: ≥ 18 years, TAVR procedure at Henry Ford Health System. Exclusion: repeat TAVR. PVIE cases were matched with controls who did not experience PVIE. PVIE defined as diagnosis documentation in the electronic medical record.

Conclusion.
The results from this study give insight to the local incidence, microbiology, and risk of PVIE following TAVR. Future directions include a larger evaluation of modifiable risks such as diabetes management and examining the heart block patients who received permanent pacemaker implants. Background. Streptococcus suis (S. suis) is a zoonotic pathogen that transmits to the human with direct contact of pig or raw pork ingestion. This infection has been described in Asia, especially Thailand, Vietnam, and China. S. suis could cause wide range of infection, including endocarditis. This study aimed to describe the clinical features, echocardiogram findings, and outcomes of S. suis endocarditis.
Methods. A single center, ten-year (January 2009 to December 2018), retrospective cohort was conducted among patients who were diagnosed with S.suis endocarditis in 1,200-bed hospital in Northern, Thailand.
Results. Forty-three patients of S.suis endocarditis were identified during the study period. Of those, 28 (65%) patients had positive blood culture and 15 (35%) was diagnosed by 16SRNA bacterial identification from heart valve tissue. Majority (81%) were male with median age of 35. There were 62 affected valves in 43 patients. Twenty patients (48%) had vegetation larger than 10 mm in diameter and 35 (81.4%) patients had moderately severe or severe valvular regurgitation. Valvular perforation was described in 23 patients (53%). Perivalvular complications were founded in 15 patients (35%). Systemic embolism occurred in 17 (40%) patients. Cardiac operation was undertaken in 35 (81%) patients. There were 2 in-hospital deaths (5%) and 6 patients (14%) had disabilities. Moderately severe/severe regurgitation, systemic embolism, and no cardiac operation were significantly associated with disability or death from univariate analysis. By logistic regression analysis, systemic embolism was the only risk factor for disability or death (OR = 12.6, 95% CI 1.3-123.5, p = 0.029).
Presenting signs/symptoms, prediction score and laboratory data on admission Conclusion. S. suis endocarditis had high rate of valvular damage with complications and resulting systemic embolism. Surgery is required in majority of the patients. Embolism was associated with disability or death.
Disclosures. Background. The province of Saskatchewan has had the highest rates of HIV and Hepatitis C in Canada for over 10 years, the majority of which is related to People who inject drugs (PWID) and with higher proportion of young women. However, the most severe complications of injection drug use (IDU) are infective endocarditis (IE) and its associated sequelae. While high rates of IE have been noted, no data exists to show the burden of infective endocarditis and its clinical outcomes. Thus, we looked to determine the mortality and impact of IE amongst PWID and also establish the epidemiology while comparing to non-PWID IE.
Methods. This is a retrospective chart review of consecutive adult patients (age > 18) admitted for IE, as defined by Duke's IE Criteria, at tertiary care hospitals in Regina, the capital city of Saskatchewan, between January 1, 2013 and December 31, 2018. PWID were identified through chart documentation of self-reported IV drug use. Outcomes included 1-year mortality, surgical intervention and referral to addiction services.
Conclusion. This cohort study of IE episodes shows for the first time the devastating impact of IDU in Saskatchewan and identifies PWID as having a 39% mortality at 1 year, which coupled with their younger age translates into an enormous years of life lost. Additionally, the over-representation of young women amongst PWID IE is consistent with the higher percentage of young women with HIV and HCV infections, and identifies them as a group that is particularly vulnerable to complications of IDU. Targeted programs for PWID, particularly towards young women at risk are urgently needed.
Disclosures. All Authors: No reported disclosures Background. In this retrospective cohort study, it was aimed to compare the clinical characteristics and outcomes of IE cases without and with an indication for cardiac surgery in terms of whether they have been operated or not, in a tertiary-care educational hospital.

Infective Endocarditis with an Indication for Cardiac Surgery in a Tertiary
Methods. Patients that were followed up for definite IE (diagnosed according to modified Duke criteria between March 2007 and November 2020) with an indication for cardiac surgery according to European Society of Cardiology Guidelines, comprised the study group. Subjects were evaluated in terms of whether these cases have been operated or not, demographic features, underlying diseases, risk factors, clinical and laboratory findings, therapy responses, complications, and mortality. The timing of surgery is defined as emergency; surgery performed within 24 hours, urgent; within a few days, elective; after at least one-two weeks of antibiotic therapy. Statistical analysis was performed via Chi square and Student T tests and a p value < 0.05 was considered significant.
Results. A total of 90 patients with an indication for surgery, 33.3% patients in underwent surgery, 66.6% patients in not underwent surgery group fulfilled the study criteria. The most frequently seen complaints in patients were fever (91.1%), coldshiver (56.6%), weight-loss (27.7%), dyspnea (25.5%), and tachycardia (20%). Heart murmur was detected during cardiac auscultation of 44 patients. Mean blood leukocyte count, C-reactive protein and erythrocyte sedimentation rate were 12324 ± 6558/ mm 3 (1408-30330), 11.46 ± 8.38 mg/dl (0.18-34.6) and 61.43 ± 33.4 mm/h (2-130), respectively. There was no significant difference between two groups in terms of cardiac/non-cardiac risk factors, age, gender, etiologic agents, laboratory findings, septic embolisms and complaints (Table 1). In total IE with an indication for surgery mortality was 27.7%. Mortality rate was significantly less and heart murmur was significantly higher in cases who underwent surgery than those did not undergo surgery (p: 0.0447).