Infective endocarditis is rare in patients with hematologic malignancy and neutropenia.
Duke's criteria
endocarditis
hematopoietic stem cell transplantation (HSCT)
neutropenia
Journal
Transplant infectious disease : an official journal of the Transplantation Society
ISSN: 1399-3062
Titre abrégé: Transpl Infect Dis
Pays: Denmark
ID NLM: 100883688
Informations de publication
Date de publication:
18 May 2024
18 May 2024
Historique:
revised:
02
05
2024
received:
04
01
2024
accepted:
08
05
2024
medline:
18
5
2024
pubmed:
18
5
2024
entrez:
18
5
2024
Statut:
aheadofprint
Résumé
Infective endocarditis (IE) is a serious complication of bloodstream infections (BSIs) that occurs at variable rates depending on the pathogen and clinical setting. There is a paucity of data describing the risk of IE in patients with hematologic malignancy who develop bacteremia while neutropenic. Adult patients on the hematology ward from January 2018 to December 2020 with hematologic malignancy and bacteremia were evaluated retrospectively for endocarditis by applying the 2023 Duke-ISCVID criteria. Charts of possible cases were evaluated 90 days after the initial BSI for new infectious complications that could indicate missed IE. Descriptive statistics compared patients admitted for hematopoietic stem cell transplantation (HSCT) to those admitted for alternative reasons (non-HSCT). Among the 1005 positive blood cultures initially identified, there were 66 episodes in 65 patients with hematologic malignancy and at least grade 3 neutropenia for a mean duration of 11.4 days during their admission. Transthoracic echocardiography (TTE) was performed in 34.8% of BSIs, and transesophageal echocardiography (TEE) in 6.1%. There were no new infectious complications in possible cases 90 days after their initial BSI. No cases of endocarditis were identified. Endocarditis is rare amongst patients with hematologic malignancy, bacteremia, and neutropenia, and no cases were identified in this cohort. The use of routine TTE in this setting seems unwarranted, and the addition of TEE is unlikely to improve patient-centered outcomes.
Sections du résumé
BACKGROUND
BACKGROUND
Infective endocarditis (IE) is a serious complication of bloodstream infections (BSIs) that occurs at variable rates depending on the pathogen and clinical setting. There is a paucity of data describing the risk of IE in patients with hematologic malignancy who develop bacteremia while neutropenic.
METHODS
METHODS
Adult patients on the hematology ward from January 2018 to December 2020 with hematologic malignancy and bacteremia were evaluated retrospectively for endocarditis by applying the 2023 Duke-ISCVID criteria. Charts of possible cases were evaluated 90 days after the initial BSI for new infectious complications that could indicate missed IE. Descriptive statistics compared patients admitted for hematopoietic stem cell transplantation (HSCT) to those admitted for alternative reasons (non-HSCT).
RESULTS
RESULTS
Among the 1005 positive blood cultures initially identified, there were 66 episodes in 65 patients with hematologic malignancy and at least grade 3 neutropenia for a mean duration of 11.4 days during their admission. Transthoracic echocardiography (TTE) was performed in 34.8% of BSIs, and transesophageal echocardiography (TEE) in 6.1%. There were no new infectious complications in possible cases 90 days after their initial BSI. No cases of endocarditis were identified.
CONCLUSIONS
CONCLUSIONS
Endocarditis is rare amongst patients with hematologic malignancy, bacteremia, and neutropenia, and no cases were identified in this cohort. The use of routine TTE in this setting seems unwarranted, and the addition of TEE is unlikely to improve patient-centered outcomes.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e14302Informations de copyright
© 2024 The Authors. Transplant Infectious Disease published by Wiley Periodicals LLC.
Références
Rajani R, Klein JL. Infective endocarditis: a contemporary update. Clin Med. 2020;20(1):31‐35.
Keynan Y, Rubinstein E. Pathophysiology of infective endocarditis. Curr Infect Dis Rep. 2013;15(4):342‐346.
Jung CJ, Yeh CY, Hsu RB, Lee CM, Shun CT, Chia JS. Endocarditis pathogen promotes vegetation formation by inducing intravascular neutrophil extracellular traps through activated platelets. Circulation. 2015;131(6):571‐581.
Chamat‐Hedemand S, Dahl A, Østergaard L, et al. Prevalence of infective endocarditis in streptococcal bloodstream infections is dependent on streptococcal species. Circulation. 2020;142(8):720‐730.
Østergaard L, Valeur N, Ihlemann N, et al. Incidence of infective endocarditis among patients considered at high risk. Eur Heart J. 2018;39(7):623‐629.
Kim SL, Gordon SM, Shrestha NK. Distribution of streptococcal groups causing infective endocarditis: a descriptive study. Diagn Microbiol Infect Dis. 2018;91(3):269‐272.
Østergaard L, Bruun NE, Voldstedlund M, et al. Prevalence of infective endocarditis in patients with positive blood cultures: a Danish nationwide study. Eur Heart J. 2019;40(39):3237‐3244.
Nilson B, Olaison L, Rasmussen M. Clinical presentation of infective endocarditis caused by different groups of non‐beta haemolytic streptococci. Eur J Clin Microbiol Infect Dis. 2016;35(2):215‐218.
Dahl A, Iversen K, Tonder N, et al. Prevalence of infective endocarditis in Enterococcus faecalis bacteremia. J Am Coll Cardiol. 2019;74(2):193‐201.
Yusuf SW, Ali SS, Swafford J, et al. Culture‐positive and culture‐negative endocarditis in patients with cancer: a retrospective observational study, 1994–2004. Medicine. 2006;85(2):86‐94.
Bai AD, Steinberg M, Showler A, et al. Diagnostic accuracy of transthoracic echocardiography for infective endocarditis findings using transesophageal echocardiography as the reference standard: a meta‐analysis. J Am Soc Echocardiogr. 2017;30(7):639‐646.e8.
Sunnerhagen T, Törnell A, Vikbrant M, Nilson B, Rasmussen M. HANDOC: a handy score to determine the need for echocardiography in Non‐β‐hemolytic Streptococcal Bacteremia. Clin Infect Dis. 2018;66(5):693‐698.
Sunnerhagen T, Højgaard Andersen M, Bruun NE, Bundgaard H, Iversen KK, Rasmussen M. External validation of the HANDOC score—high sensitivity to identify patients with non‐beta‐haemolytic streptococcal endocarditis. Infect Dis. 2020;52(1):54‐57.
Palraj BR, Baddour LM, Hess EP, et al. Predicting risk of endocarditis using a clinical tool (PREDICT): scoring system to guide use of echocardiography in the management of Staphylococcus aureus Bacteremia. Clin Infect Dis. 2015;61(1):18‐28.
Tubiana S, Duval X, Alla F, et al. The VIRSTA score, a prediction score to estimate risk of infective endocarditis and determine priority for echocardiography in patients with Staphylococcus aureus bacteremia. J Infect. 2016;72(5):544‐553.
Bouza E, Kestler M, Beca T, et al. The NOVA score: a proposal to reduce the need for transesophageal echocardiography in patients with enterococcal bacteremia. Clin Infect Dis. 2015;60(4):528‐535.
Berge A, Krantz A, Östlund H, Nauclér P, Rasmussen M. The DENOVA score efficiently identifies patients with monomicrobial Enterococcus faecalis bacteremia where echocardiography is not necessary. Infection. 2019;47(1):45‐50.
Richard P, Amador Del Valle G, Moreau P, et al. Viridans streptococcal bacteraemia in patients with neutropenia. Lancet. 1995;345(8965):1607‐1609.
Fowler VG, Durack DT, Selton‐Suty C, et al. The 2023 Duke‐International Society for Cardiovascular Infectious Diseases criteria for infective endocarditis: updating the modified Duke criteria [published correction appears in Clin Infect Dis. 2023 Oct 13;77(8):1222]. Clin Infect Dis. 2023;77(4):518‐526.
Bochud PY, Eggiman P, Calandra T, Van Melle G, Saghafi L, Francioli P. Bacteremia due to viridans streptococcus in neutropenic patients with cancer: clinical spectrum and risk factors. Clin Infect Dis. 1994;18(1):25‐31.
Beteille E, Guarana M, Nucci M. Infective endocarditis in neutropenic patients with viridans streptococci bacteraemia. Clin Microbiol Infect. 2018;24(8):916‐917.
Safdar A, Childs BH, Keefe D, Sepkowitz KA. Acute bacterial endocarditis during granulocytopenia in an allogenic marrow transplant recipient. Am J Med. 2000;109(6):514‐515.
Gassas A, Grant R, Richardson S, Dupuis LL, Doyle J, Allen U, Abla O, Sung L. Predictors of viridans streptococcal shock syndrome in bacteremic children with cancer and stem‐cell transplant recipients. J Clin Oncol. 2004;22(7):1222‐1227.
Chesdachai S, Yetmar ZA, Tabaja H, Comba IY, Go JR, Challener DW, Misra A, Abu Saleh OM. Contemporary experience of Abiotrophia, Granulicatella and Gemella bacteremia. J Infect. 2022;84(4):511‐517.
Venditti M, Falcone M, Micozzi A, et al. Staphylococcus aureus bacteremia in patients with hematologic malignancies: a retrospective case‐control study. Haematologica. 2003;88(8):923‐930.