Enterococcus Faecalis in Endocarditis: Second Most Common Endocarditis Pathogen on the Rise? Data from the Brandenburg Endocarditis Registry

Background: Despite modern diagnostic methods, the treatment and outcome of the disease remains almost unchanged. Over the last decades, the proportion of pathogens in endocarditis has changed. Pathogen type plays a relevant role not only in therapy but also in the course of the disease.

Methods: In a multicenter, prospective study (Brandenburg Endocarditis Registry), the responsible pathogen was identified beyond doubt in 324 endocarditis patients. In 25.9% of the cases, Staphylococcus aureus (S. aureus) was detected, in 20.7% Enterococcus faecalis (E. faecalis), and in 15.4% Streptococcus viridans. We analyzed the clinical, diagnostic, and therapeutic aspects as well as outcome of patients with E. faecalis endocarditis compared to the other bacteria.

Results: E. faecalis was significantly more often observed in prosthetic valve and Pacemaker-associated-Endocarditis (p = 0.032, p = 0.05). E. faecalis-endocarditis was significantly more often caused by urogenital sepsis and significantly less often by soft tissue infections (p = 0.041, p = 0.003). Perivalvular abscess and early endocarditis were observed frequently but were not statistically significant. Comparative analysis with Streptococcus viridans endocarditis showed that patients with E. faecalis endocarditis were significantly older (p = 0.016), more frequently pre-operated, dialysis dependent (p = 0.048; p = 0.011) and suffered from acute renal failure (p = 0.004). Compared to S. aureus, septic shock, vasoplegia, and multi-organ failure were less frequent (p = 0.004) and mortality was lower (p = 0.008).

Conclusion: E. faecalis has taken over second place from Streptococcus viridans and seems to be more aggressive. The reason for this could be the demographic change, which leads to more and more elderly and frail patients being admitted to hospital. Fortunately, the consequences seem to be less severe compared to S. aureus endocarditis. The specific risks, such as pacemaker or heart valve wearers, can be identified for prophylactic measures or treated early in the case of urogenital sepsis.

Publication History

Article published online:
13 February 2024