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Infective endocarditis due to Streptococcus dysgalactiae: clinical presentation and microbiological features

Artikel i vetenskaplig tidskrift
Författare A. Blackberg
B. Nilson
V. Ozenci
Lars Olaison
M. Rasmussen
Publicerad i European Journal of Clinical Microbiology & Infectious Diseases
Volym 37
Nummer/häfte 12
Sidor 2261-2272
ISSN 0934-9723
Publiceringsår 2018
Publicerad vid Institutionen för biomedicin, avdelningen för infektionssjukdomar
Sidor 2261-2272
Språk en
Länkar dx.doi.org/10.1007/s10096-018-3367-...
Ämnesord Streptococcus dysgalactiae, Infective endocarditis, Antibiotic susceptibility, emm type, beta-hemolytic streptococci, group-c, group-a, equisimilis, management, susceptibility, gentamicin, mechanism, diagnosis, synergy, Infectious Diseases, Microbiology, crobiology, v20, p59
Ämneskategorier Mikrobiologi inom det medicinska området

Sammanfattning

Knowledge of infective endocarditis (IE) caused by Streptococcus dysgalactiae (SD) is limited. This study aimed to identify the clinical and microbiological features of SD-caused IE and to investigate any possible synergy between penicillin and gentamicin on SD isolates. Cases of IE 2008-2016 due to SD reported to the Swedish Registry of Infective Endocarditis (SRIE) were identified. Isolates were emm typed and synergy between antibiotics was determined in time-kill experiments. Medical records were reviewed and SD-cases were compared to cases of IE due to other pathogens reported to the SRIE. Fifty cases of SD-caused IE were confirmed. emm types stC74a, stG62647, and stG643 were most commonly encountered. The patients had a median age of 74years (range 38-93) and were significantly older compared to patients with Staphylococcus aureus-caused IE, (65years (p=0.003)). The median time to diagnosis from symptom onset was 1day for patients with SD-caused IE which was less compared to patients with IE due to the other pathogens (2-15days). Embolization was seen in 46% and the in-hospital mortality was 8%. Etest-based methods did not indicate any synergy between penicillin and gentamicin whereas synergy was noted for four out of nine isolates applying time-kill assays. This is the largest study of SD-caused IE, a condition with an acute onset predominantly affecting elderly people. Synergy between penicillin and gentamicin against some SD isolates was distinguished but the potential benefit of this must be weighed against the risk of aminoglycoside side effects.

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