ArticleBMC infectious diseases2021
Proposal for the use of echocardiography in bloodstream infections due to different streptococcal species.
Article in BMC infectious diseases, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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10 citing papers in PubMed, 22 citations in OpenAlex.
- Infective Endocarditis on Aortic Valve: From Diagnosis to Cardiac Surgical Intervention-Narrative Review.Journal of clinical medicine · 2026Review
- Article
- Non-β-hemolytic Streptococcal Bacteremia in Patients With Heart Valve Prosthesis-Is It Always Infective Endocarditis?Open forum infectious diseases · 2025Article
- Interpreting Blood Culture Results as Early Guidance for Infective Endocarditis.JAMA network open · 2025Article
- Pneumococcal Endocarditis, Sepsis, and Meningitis in an Immunocompromised Patient: A Case Study.The American journal of case reports · 2024Article
- Review
- Evaluation of the HANDOC Score and the 2023 International Society of Cardiovascular Infectious Diseases and European Society of Cardiology Duke Clinical Criteria for the Diagnosis of Infective Endocarditis Among Patients With Streptococcal Bacteremia.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2024Article
- Performance of the 2023 Duke-International Society of Cardiovascular Infectious Diseases Diagnostic Criteria for Infective Endocarditis in Relation to the Modified Duke Criteria and to Clinical Management-Reanalysis of Retrospective Bacteremia Cohorts.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2024Article
- Infective Endocarditis Due toMicroorganisms · 2024Review
- Time to Blood Culture Positivity: An Independent Predictor of Mortality inOpen forum infectious diseases · 2022Article
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11 authors at 5 institutions in 1 country.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundInfective endocarditis (IE) is diagnosed in 7-8% of streptococcal bloodstream infections (BSIs), yet it is unclear when to perform transthoracic (TTE) and transoesophageal echocardiography (TOE) according to different streptococcal species. The aim of this sub-study was to propose a flowchart for the use of echocardiography in streptococcal BSIs.
methodsIn a population-based setup, we investigated all patients admitted with streptococcal BSIs and crosslinked data with nationwide registries to identify comorbidities and concomitant hospitalization with IE. Streptococcal species were divided in four groups based on the crude risk of being diagnosed with IE (low-risk < 3%, moderate-risk 3-10%, high-risk 10-30% and very high-risk > 30%). Based on number of positive blood culture (BC) bottles and IE risk factors (prosthetic valve, previous IE, native valve disease, and cardiac device), we further stratified cases according to probability of concomitant IE diagnosis to create a flowchart suggesting TTE plus TOE (IE > 10%), TTE (IE 3-10%), or "wait & see" (IE < 3%).
resultsWe included 6393 cases with streptococcal BSIs (mean age 68.1 years [SD 16.2], 52.8% men). BSIs with low-risk streptococci (S. pneumoniae, S. pyogenes, S. intermedius) are not initially recommended echocardiography, unless they have ≥3 positive BC bottles and an IE risk factor. Moderate-risk streptococci (S. agalactiae, S. anginosus, S. constellatus, S. dysgalactiae, S. salivarius, S. thermophilus) are guided to "wait & see" strategy if they neither have a risk factor nor ≥3 positive BC bottles, while a TTE is recommended if they have either ≥3 positive BC bottles or a risk factor. Further, a TTE and TOE are recommended if they present with both. High-risk streptococci (S. mitis/oralis, S. parasanguinis, G. adiacens) are directed to a TTE if they neither have a risk factor nor ≥3 positive BC bottles, but to TTE and TOE if they have either ≥3 positive BC bottles or a risk factor. Very high-risk streptococci (S. gordonii, S. gallolyticus, S. mutans, S. sanguinis) are guided directly to TTE and TOE due to a high baseline IE prevalence.
conclusionIn addition to the clinical picture, this flowchart based on streptococcal species, number of positive blood culture bottles, and risk factors, can help guide the use of echocardiography in streptococcal bloodstream infections. Since echocardiography results are not available the findings should be confirmed prospectively with the use of systematic echocardiography.
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