Infective Endocarditis Related to Unusual Microorganisms: A Prospective Population-Based Study
Authors: Limonta Silvia , Cambau Emmanuelle , Erpelding Marie-Line , Piau-Couapel Caroline , Goehringer François , Plésiat Patrick , Revest Matthieu , Vernet-Garnier Véronique , Moing Vincent Le , Hoen Bruno , Duval Xavier , Tattevin Pierre ,   for the EI 2008 de l’AEPEI working group, Hoen B , Duval X , Alla F , Bouvet A , Briançon S , Cambau E , Celard M , Chirouze C , Danchin N , Doco-Lecompte T , Delahaye F , Etienne J , Iung B , Le Moing V , Obadia J F , Leport C , Poyart C , Revest M , Selton-Suty C , Strady C , Tattevin P , Vandenesch F , Bernard Y , Chocron S , Chirouze C , Hoen B , Plesiat P , Abouliatim I , De Place C , Tattevin P , Revest M , Donnio P Y , Alla F , Carteaux J P , Doco-Lecompte T , Lion C , Aissa N , Selton-Suty C , Baehrel B , Jaussaud R , Nazeyrollas P , Strady C , Vernet V , Cambau E , Duval X , Iung B , Nataf P , Chidiac C , Celard M , Delahaye F , Obadia J F , Vandenesch F , Aumaître H , Frappier J M , Le Moing V , Oziol E , Sotto A , Sportouch C , Poyart C , Bouvet A , Vandenesch F , Celard M , Bes M , Abassade P , Abrial E , Acar C , Aissa N , Alexandra J F , Amireche N , Amrein D , Andre P , Appriou M , Arnould M A , Assayag P , Atoui A , Aziza F , Baille N , Bajolle N , Battistella P , Baumard S , Ben Ali A , Bertrand J , Bialek S , Bois Grosse M , Boixados M , Borlot F , Bouchachi A , Bouche O , Bouchemal S , Bourdon J L , Bouvet A , Brasme L , Bricaire F , Brochet E , Bruntz J F , Cady A , Cailhol J , Caplan M P , Carette B , Carteaux J P , Cartry O , Cazorla C , Celard M , Chamagne H , Champagne H , Chanques G , Chastre J , Chevalier B , Chirouze C , Chometon F , Christophe C , Cohen A , Colin de Verdiere N , Danchin N , Daneluzzi V , David L , De Lentdecker P , Delahaye F , Delcey V , Deleuze P , Donal E , Duval X , Deroure B , Descotes-Genon V , Didier Petit K , Dinh A , Doat V , Duchene F , Duhoux F , Dupont M , Ederhy S , Epaulard O , Evest M , Faucher J F , Fantin B , Fauveau E , Ferry T , Fillod M , Floch T , Fraisse T , Frapier J M , Freysz L , Fumery B , Gachot B , Gallien S , Gandjbach I , Garcon P , Gaubert A , Genoud J L , Ghiglione S , Godreuil C , Grentzinger A , Groben L , Gherissi D , Guéret P , Hagege A , Hammoudi N , Heliot F , Henry P , Herson S , Hoen B , Houriez P , Hustache-Mathieu L , Huttin O , Imbert S , Iung B , Jaureguiberry S , Kaaki M , Konate A , Kuhn J M , Kural Menasche S , Lafitte A , Lafon B , Lanternier F , Le Chenault V , Le Moing V , Lechiche C , Lefèvre-Thibaut S , Lefort A , Leguerrier A , Lemoine J , Lepage L , Leport C , Lepousé C , Leroy J , Lesprit P , Letranchant L , Loisance D , Loncar G , Lorentz C , Mabo P , Magnin-Poull I , May T , Makinson A , Man H , Mansouri M , Marcxon O , Maroni J P , Masse V , Maurier F , Meyohas M C , Michel P L , Michelet C , Mechaï F , Merceron O , Messika-Zeitoun D , Metref Z , Meyssonnier V , Mezher C , Micheli S , Monsigny M , Mouly S , Mourvillier B , Nallet O , Nataf P , Nazeyrollas P , Noel V , Obadia J F , Oziol E , Papo T , Payet B , Pelletier A , Perez P , Petit J S , Philippart F , Piet E , Plainvert C , Popovic B , Porte J M , Pradier P , Ramadan R , Revest M , Richemond J , Rodermann M , Roncato M , Roigt I , Ruyer O , Saada M , Schwartz J , Selton-Suty C , Simon M , Simorre B , Skalli S , Spatz F , Strady C , Sudrial J , Tartiere L , Terrier De La Chaise A , Thiercelin M C , Thomas D , Thomas M , Toko L , Tournoux F , Tristan A , Trouillet J L , Tual L , Vahanian A , Verdier F , Vernet Garnier V , Vidal V , Weyne P , Wolff M , Wynckel A , Zannad N , Zinzius P Y 
Published: April 2020

Abstract

Background
Increased access to heart valves through early surgery and progress in molecular microbiology have reduced the proportion of infective endocarditis (IE) with no microbiological documentation and increased the proportion of IE associated with unusual microorganisms.

Methods
We performed an ancillary study of a large prospective population-based survey on IE. Unusual-microorganism IE was defined as definite IE (Duke-Li criteria) due to microorganisms other than streptococci, staphylococci, or enterococci.

Results
Of 471 cases of documented IE, 46 (9.8%) were due to unusal microorganisms; the following were involved in &gt;1 case: Candida albicans (n = 4), Cutibacterium acnes (n = 4), Pseudomonas aeruginosa (n = 3), Cardiobacterium hominis (n = 3), and Coxiella burnetii (n = 2). Cases were documented with blood cultures (n = 37, 80.4%), heart valve polymerase chain reaction (PCR; n = 5), heart valve culture (n = 2), PCR on vertebral biopsy (n = 1), or serology (n = 1). As compared with IE due to staphylococci, streptococci, or enterococci (n = 420), IE due to unusual microorganisms occurred more frequently in patients with previously known heart disease (69.0% vs 44.3%; P = .002), prosthetic valve (40.5% vs 18.1%; P = .0006), longer duration of fever (mean, 35.1 ± 46.8 days vs 12.5 ± 17.8; P = .003), and who were more often nosocomial (38.1% vs 20.2%; P = .02).

Conclusions
In this population-based study, 9.8% of IE cases were due to unusual microorganisms, with a predominance of anaerobes, yeast, and gram-negative bacilli. As compared with IE related to staphylococci, streptococci, or enterococci, IE cases related to unusual microorganisms were associated with previously known heart disease, prosthetic valve, longer duration of fever, and nosocomial acquisition.

Trial registration
ORCID 0000-0003-3617-5411