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PNEUMOCOCCAL INFECTIVE ENDOCARDITIS IN BRAZIL: A MULTICENTER STUDY ON A SEVERE CONDITION
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Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.
Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas. Instituto do Coração. São Paulo, SP, Brasil.
Universidade Federal do Rio de Janeiro. Rio de Janeiro, RJ, Brasil.
Universidade do Estado do Rio de Janeiro. Rio de Janeiro, RJ, Brasil / Universidade Federal do Estado do Rio de Janeiro. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil / Instituto Nacional de Cardiologia. Rio de Janeiro, RJ, Brasi.
Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas. Instituto do Coração. São Paulo, SP, Brasil.
Universidade Federal do Rio de Janeiro. Rio de Janeiro, RJ, Brasil.
Universidade do Estado do Rio de Janeiro. Rio de Janeiro, RJ, Brasil / Universidade Federal do Estado do Rio de Janeiro. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil / Instituto Nacional de Cardiologia. Rio de Janeiro, RJ, Brasi.
Abstract
Background: Streptococcus pneumoniae bacteremia may result in Infective Endocarditis (IE). In the pre-antibiotic era, it caused 10 %‒15 % of IE, decreasing to < 3 % after penicillin availability. Although infrequent, it causes aggressive disease. Methods: Retrospective analysis of endocarditis databases, prospectively implemented in 4 Brazilian institutions, 2005‒2023. Results: From the prospective cohorts comprising 2321 adult patients with IE, we identified 11 (0.47%) with pneumococcal IE. Males represented 7/11 and mean age was 54 years (22‒77). All had native valve involvement; perivalvular abscess was present in 6/11. Only one patient had concurrent meningitis. Beta-lactams were the antibiotics used in 10/11. All had surgical indication, but only 6 had it, as the others were seriously ill. Overall, in hospital mortality was 6/11, but only 1/6 of those who underwent surgery died, compared to 5/5 of those who had an indication for surgery and did not have it. Conclusions: The high mortality rates and need for surgical intervention emphasize the need to promptly identify and manage pneumococcal endocarditis. Physicians ought to recommend vaccination to all patients at risk for severe pneumococcal disease.
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