Is Echocardiography Mandatory for All Subsp. Bacteremia?

Background: , formerly known as one of the group, is frequently associated with endocarditis. Current guidelines recommended diagnostic work-up for endocarditis among patients with bacteremia. However, subsp. , was found to be associated with neonatal sepsis and liver diseases and is less commonly associated with endocarditis compared with subsp. . Our study aimed to identify the risk factors for subsp. endocarditis to help select the patients for echocardiography.

Methods: In this retrospective cohort study, medical records from all adult patients with subsp. isolated from blood cultures at Phramongkutklao Hospital from 2009 to 2015 were reviewed. Patients who had mixed bacteremia or missing records were excluded from the study.

Results: During the study period, subsp. was isolated among 106 individuals. Mean age was 66.9±15.6 years. Most patients (61.3%) were male, with cirrhosis as the most common underlying diseases (46.2%), followed by malignancy and chronic kidney disease. Most common manifestations included primary bacteremia (44.3%), followed by spontaneous bacterial peritonitis (23.6%). Infective endocarditis was found among 9 patients. No patients with cirrhosis or single blood specimen of bacteremia had endocarditis (RR 0; p-value 0.003, and RR 1.35; p-value 0.079). The common complications associated with endocarditis were acute respiratory failure (RR 4.32; p-value 0.05), whereas acute kidney injury was a protective factor (RR 0; p-value 0.01). Among 76 patients who had records of 2-year follow-up, no new diagnosis of endocarditis or malignancy was observed.

Conclusion: Among patients with subsp. bacteremia, echocardiography might not be needed among patients with cirrhosis and without sustained bacteremia.