Beta-Hemolytic Streptococcal Infective Endocarditis: Characteristics and Outcomes From a Large, Multinational Cohort.
Background
Beta-hemolytic streptococci (BHS) are an uncommon cause of infective endocarditis (IE). The aim of this study was to describe the clinical features and outcomes of patients with BHS IE in a large multinational cohort and compare them with patients with viridans streptococcal IE.


Methods
The International Collaboration on Endocarditis Prospective Cohort Study (ICE-PCS) is a large multinational database that recruited patients with IE prospectively using a standardized data set. Sixty-four sites in 28 countries reported patients prospectively using a standard case report form developed by ICE collaborators.


Results
Among 1336 definite cases of streptococcal IE, 823 were caused by VGS and 147 by BHS. Patients with BHS IE had a lower prevalence of native valve (P < .005) and congenital heart disease predisposition (P = .002), but higher prevalence of implantable cardiac device predisposition (P < .005). Clinically, they were more likely to present acutely (P < .005) and with fever (P = .024). BHS IE was more likely to be complicated by stroke and other systemic emboli (P < .005). The overall in-hospital mortality of BHS IE was significantly higher than that of VGS IE (P = .001). In univariate analysis, variables associated with in-hospital mortality for BHS IE were age (odds ratio [OR], 1.044; P = .004), prosthetic valve IE (OR, 3.029; P = .022), congestive heart failure (OR, 2.513; P = .034), and stroke (OR, 3.198; P = .009).


Conclusions
BHS IE is characterized by an acute presentation and higher rate of stroke, systemic emboli, and in-hospital mortality than VGS IE. Implantable cardiac devices as a predisposing factor were more often found in BHS IE compared with VGS IE.
['Fernández Hidalgo|Núria|N|', 'Gharamti|Amal A|AA|0000-0002-6175-299X', 'Aznar|María Luisa|ML|', 'Almirante|Benito|B|', 'Yasmin|Mohamad|M|', 'Fortes|Claudio Querido|CQ|', 'Plesiat|Patrick|P|', 'Doco-Lecompte|Thanh|T|', 'Rizk|Hussein|H|', 'Wray|Dannah|D|', 'Lamas|Cristiane|C|', 'Durante-Mangoni|Emanuele|E|', 'Tattevin|Pierre|P|', 'Snygg-Martin|Ulrika|U|', 'Hannan|Margaret M|MM|', 'Chu|Vivian H|VH|', 'Kanafani|Zeina A|ZA|']
infective endocarditis beta-hemolytic streptococci International Collaboration on Endocarditis cardiac devices congestive heart failure