Streptococcus Suis Infective Endocarditis in Patients With Streptococcus Suis Septicemia : A Retrospective Study of Prevalence and Outcomes

doi:10.21203/rs.3.rs-4889837/v1

Download PDF

Research Article

Streptococcus Suis Infective Endocarditis in Patients With Streptococcus Suis Septicemia : A Retrospective Study of Prevalence and Outcomes

https://doi.org/10.21203/rs.3.rs-4889837/v1

This work is licensed under a CC BY 4.0 License

Journal Publication

published 14 Nov, 2024

Read the published version in BMC Infectious Diseases →

You are reading this latest preprint version

Background

Streptococcus suis (S. suis) is a zoonotic disease that transmits to humans by contact or oral route. Although the major clinical presentation of this pathogen has been known as meningitis, S. suis infective endocarditis (IE) has recently emerged as a field of interest. However, echocardiography is underutilized in patients with S. suis septicemia.

Objective

The primary objective was to study the prevalence of S. suis IE in patients with S. suis septicemia. The secondary objective was to assess the predictors, echocardiographic features, and clinical outcomes.

Materials and method

The authors conducted a single-center retrospective study. The patients who were older than 18 years and admitted to Siriraj Hospital due to S. suis septicemia between January 2007 and September 2023 were included. Prevalence was defined as a percent and confidence interval (CI). Univariable and multivariable analyses were performed to determine the predictors of S. suis IE. Baseline characteristics and clinical outcomes of patients with and without IE were compared. A p-value < 0.05 was defined as statistically significant.

Result

A total of 71 patients with S. suis septicemia were included in the study. The prevalence of S. suis IE was 26.8% (95%CI 17.85 to 38.05) and heart failure was an independent predictor of IE. Perivalvular complications and significant valvular regurgitation were found in 52.6% and 80%, respectively. 13 out of 19 patients (68.4%) required valvular surgery according to standard guidelines.

Conclusion

The present study reveals a sizable proportion of S. suis IE in patients with S. suis septicemia, in conjunction with a high rate of valvular damage and perivalvular complications. Therefore, echocardiography should be considered in patients with S. suis septicemia, especially with a heart failure presentation. Further reclassification of this pathogen as a “typical” organism should be deliberated.

Echocardiography

Streptococcus suis

Infective endocarditis

Streptococcus suis (S. suis) is a gram-positive alpha-hemolytic diplococci bacterium mainly colonized in pigs’ respiratory tracts, spreading to humans by contact or oral route. This pathogen is increasingly recognized as a cause of serious infection globally, especially in Southeast Asia. Many clinical syndromes have been described, such as septicemia, meningitis, septic arthritis, and infective endocarditis (IE).^(1–5) Previous research has indicated that IE caused by S. suis affects around 6.4–25.6% of cases.^(1,2,6) The aggressive nature of this bacterium can result in a significant rate of valvular destruction, perivalvular complications, and distal embolization.^(4,7) Additionally, a significant proportion of patients required valvular surgery as a sequelae of these complications.^(4,7) Despite the sizable prevalence and poor clinical outcomes of S. suis IE, there are still no recommendations on routine echocardiography for S. suis septicemia, unlike in cases of Staphylococcus aureus (S. aureus) septicemia, according to the 2015 European Society of Cardiology (ESC) guideline.⁽⁸⁾

The present study aims to demonstrate the prevalence of S. suis IE in patients with S. suis septicemia and evaluate predictors, clinical outcomes, and echocardiographic features. The results would add valuable data on clinical decision-making in patients with S. suis septicemia, and moreover, may alter the guidelines for routine echocardiographic screening.

Study design and participants

We conducted a single center retrospective study. The patients admitted to Department of Medicine, Siriraj Hospital, Bangkok, Thailand, between January 1st, 2007, and September 30th, 2023, due to S. suis septicemia, were enrolled in the study.

The inclusion criteria were consecutive patients older than 18 years admitted to Siriraj Hospital with at least one sample of blood culture positive for S. suis plus the echocardiographic evidence of endocarditis. IE included both “definite IE”, as defined by two major or one major plus three minor criteria, and “possible IE”, as defined by one major and one minor criteria, as described in the 2015 ESC guideline.⁽⁸⁾ Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) were performed according to primary physician’s decision. The exclusion criteria were pregnant women and patients with inadequate medical records. The present study was approved by the Ethical Committee for Human Research, Faculty of Medicine, Siriraj Hospital, Mahidol University.

Measurement and outcomes

Patient data were searched using the keyword ‘’Streptococcus suis’’ from SiDATAplus. There were 71 patients with S. suis septicemia included in the study. Baseline characteristics, echocardiographic results, and clinical outcomes were reviewed from the patient’s electronic medical records. The primary outcome was the prevalence of S. suis IE in patients with S. suis septicemia. The secondary outcomes were echocardiographic features, predictors, and outcomes of S. suis IE.

Statistical analysis

The analyses were performed using SPSS Statistics software version 26 for Windows (SPSS Inc., Chicago, IL). Descriptive statistics were used to summarize patient demographics and baseline characteristics. Normally distributed continuous variables were described as mean ± standard deviation (SD), while non-normally distributed continuous variables were reported as median and interquartile range (IQR). The student’s t-test was used to compare normally distributed data, and the Mann-Whitney U test was used for non-normally distributed data. Categorical variables were presented as the number of cases and percentage. The chi-square or Fischer’s exact test was used to determine whether a difference existed between groups. Variables with a p-value lower than 0.05 were considered statistically significant. Factors that showed statistical significance were further analyzed using binary logistic regression analysis to determine the predictors of S. suis IE in patients with S. suis septicemia. The data were expressed as odds ratios (OR) and 95% confidence intervals (CI). Any predictors that could not be directly calculated for crude OR were estimated using the Analysis of Binary Data (David R. Cox and E. J. Snell method) with + 0.5 smoothing for calculating the empirical logit transform to estimate the OR.

A total of 71 patients were enrolled in the study. The prevalence of S. suis IE in patients with S. suis septicemia was 19 out of 71 patients (26.8%, 95%CI 17.85 to 38.05). Baseline characteristics, presenting symptoms, and clinical syndromes are shown in Table 1. The median age was 59.9 years, and 56.3% were male. Half of the patients had hypertension and approximately one-fifth had diabetes. Only a small proportion (4%) had a history of previously diagnosed valvular heart disease and none of them underwent cardiac surgery. The most common presentation in the overall cohort was fever (85.8%), whereas dyspnea, immunologic phenomena, new murmurs, and heart failure were more prevalent in IE group. IE was the second most common clinical syndromes in our S. suis septicemia cohort. There was an increasing trend in the incidence of S. suis septicemia, corresponding with S. suis IE, with the peak incidence in 2021, as shown in Fig. 1.

Table 1

Baseline characteristics, presenting symptoms, and clinical syndromes
	All (n = 71)	IE (n = 19)	No IE (n = 52)	p-value
Baseline characteristics
Age(years)	59.9 ± 15.1	55.5 ± 15.5	61.5 ± 14.8	0.140
Sex: male	40 (56.3)	10 (52.6)	30 (57.7)	0.703
Height (cm)	161.2 ± 9.8	162.8 ± 8.0	160.6 ± 10.5	0.407
Weight (kg)	60.3 ± 10.3	60.1 ± 9.9	60.3 ± 10.7	0.922
BMI (kg/cm²)	23.1 ± 3.5	22.6 ± 3.0	23.4 ± 3.7	0.416
Hypertension	34 (47.9)	6 (31.6)	28 (53.8)	0.096
Diabetes mellitus	13 (18.3)	2 (10.5)	11 (21.2)	0.491
Coronary artery disease	8 (11.3)	1 (5.3)	7 (13.5)	0.673
Atrial fibrillation	3 (4.2)	0 (0.0)	3 (5.8)	0.559
Valvular heart disease	3 (4.2)	0 (0.0)	3 (5.8)	0.559
Rheumatic heart disease	0 (0.0)	0 (0.0)	0 (0.0)	N/A
Previous infective endocarditis	0 (0.0)	0 (0.0)	0 (0.0)	N/A
Presence of CIED	1 (1.4)	0 (0.0)	1 (1.9)	1.0
History of valve replacement	0 (0.0)	0 (0.0)	0 (0.0)	N/A
Intravenous drug use	0 (0.0)	0 (0.0)	0 (0.0)	N/A
Chronic kidney disease	3 (4.2)	0 (0.0)	3 (5.8)	0.559
Cirrhosis	2 (2.9)	0 (0.0)	2 (3.8)	1.000
Old cerebrovascular disease	7 (9.9)	2 (10.5)	5 (9.6)	1.000
Immunosuppressive drug or steroid use	1 (1.4)	0 (0.0)	1 (1.9)	1.000
thalassemia	1 (1.4)	0 (0.0)	1 (1.9)	1.000
HIV infection	3 (4.2)	0 (0.0)	3 (5.8)	0.559
Presenting symptoms
Fever	61 (85.9)	18 (94.7)	43 (82.7)	0.270
Dyspnea	16 (22.5)	9 (47.4)	7 (13.5)	0.008
Seizure	3 (4.2)	0 (0.0)	3 (5.8)	0.559
Headache	17 (24.3)	2 (11.1)	15 (28.8)	0.203
New murmur	15 (21.1)	15 (78.9)	0 (0.0)	< 0.001
Immunologic phenomenon	3 (4.2)	3 (15.8)	0 (0.0)	0.017
Vascular phenomena	2 (2.8)	2 (10.5)	0 (0.0)	0.069
Septic shock	8 (11.3)	3 (15.8)	5 (9.6)	0.434
Stroke/Septic emboli	5 (7.0)	2 (10.5)	3 (5.8)	0.605
Heart failure	10 (14.1)	9 (47.4)	1 (1.9)	< 0.001
Organ specific infection
Meningitis	22 (31.0)	4 (21.1)	18 (34.6)	0.329
Intraabdominal infection	4 (5.6)	1 (5.3)	3 (5.8)	1.000
Skin and soft tissue	3 (4.2)	0 (0.0)	3 (5.8)	0.559
Osteomyelitis	7 (9.9)	3 (15.8)	4 (7.7)	0.375
Arthritis	11 (15.5)	2 (10.5)	9 (17.3)	0.715
Catheter related infection	0 (0.0)	0 (0.0)	0 (0.0)	N/A
Endopthalmitis	1 (1.4)	0 (0.0)	1 (1.9)	1.000
Pneumonia	4 (5.6)	2 (10.5)	2 (3.8)	0.289
Primary bacteremia	18 (25.3)	0 (0.0)	18 (34.6)	0.002
Data were expressed as mean ± standard deviation or number (percentage)

[Table 1 place here]

Figure 1. Number of Patients with S. suis IE and S. suis septicemia admitted to Siriraj Hospital from January 1st, 2007, and September 30th, 2023.

Univariate analysis was performed in four factors and expressed as a crude OR. Since new murmurs and immunologic phenomena were not found in non-IE group, the crude OR cannot be calculated for these factors. An analysis of Binary Data using + 0.5 smoothing for the empirical logit transform was applied to estimate the crude OR for these two factors. There were only two factors included in multivariate analyses, which were heart failure and dyspnea. We found that only heart failure was an independent predictor of S. suis IE in the patients with S. suis septicemia (Table 2).

Table 2

Univariate and multivariate analyses of the factors that predict IE in *S. suis* septicemia.
	Univariate analysis		Multivariate analysis
	Crude OR	95% CI	Adjusted OR	95%CI	p-value
Dyspnea	5.78	1.74–19.25	1.5	0.27–8.33	0.643
New murmur	364.67*	18.45-7093.59	N/A
Immunologic phenomenon	22.27*	1.09-453.86	N/A
Heart failure	45.90	5.22-403.75	35.61	3.24-390.44	0.003

CI;confidence intervals, OR;odds ratio, *Analysis of binary data using + 0.5 smoothing for calculating the empirical logit transform (David R. Cox and E. J. Snell) was applied to estimate the odds ratio

TTE and TEE were performed in 30 (42.3%) and 7 (9.9%) out of the 71 patients, respectively. In the IE group, TTE and TEE were performed in 19 (100%) and 7 (36.8%) patients, respectively. In the non-IE group, TTE was performed in only 11 (21.2%) patients and none underwent TEE. The echocardiographic parameters differed between the IE and non-IE groups. Left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV), left ventricular dimension during diastole (LVDd), and left ventricular dimension during systole (LVDs) were significantly higher in IE group, whereas left ventricular ejection fraction (LVEF) and right ventricular function parameters were not significantly different between the two groups (Table 3).

Table 3

Echocardiographic parameters according to the presence or absence of IE
	IE ( n = 19)	No IE ( n = 11)	p-value
LVEDV (mL)	115.7 ± 37.9	73.4 ± 24.4	0.002
LVESV (mL)	38.6 ± 21.1	23.1 ± 8.2	0.010
LVEF (%)	62.8 ± 11.2	65.2 ± 5.7	0.542
LVDd (mm)	48.8 ± 6.9	40.3 ± 6.0	0.004
LVDs (mm)	30.8 ± 6.1	25.0 ± 3.8	0.021
LV mass index (g/m²)	111.7 ± 33.6	94.7 ± 38.1	0.264
RWT	0.4 ± 0.1	0.6 ± 0.1	0.002
LA volume index (mL/m²)	36.7 ± 13.0	31.3 ± 15.8	0.344
TAPSE (mm)	25.1 ± 6.3	18.5 ± 9.9	0.079
Peak lateral TV annulus velocity (cm/s)	16.6 ± 4.3	14.2 ± 4.7	0.324
RAP(mmHg)	9.2 ± 3.2	6.9 ± 3.5	0.103
RVSP (mmHg)	46.2 ± 18.9	34.9 ± 23.8	0.342
Mean PAP (mmHg)	29.4 ± 9.5	17.8 ± 5.4	0.070

Data were express as mean ± SD, IE;infective endocarditis, LA;left atrium, LV;left ventricle, LVDd;left ventricular dimension during diastole, LVDs;left ventricular dimension during systole, LVEDV;left ventricular end diastolic volume, LVEF;left ventricular ejection fraction, LVESV;left ventricular end systolic volume, PAP;pulmonary artery pressure, RWT;relative wall thickness, TAPSE;tricuspid annular plane systolic excursion, RAP;right atrial pressure, RVSP;right ventricular systolic pressure, TV;tricuspid valve

The echocardiographic features of IE are presented in Table 4. There was a total of 25 lesions, with the most common valve affected by S. suis infection being the aortic valve (52%), followed by the mitral valve (44%). Double-valve involvement (aortic and mitral valves) was detected in 6 patients. The median size of vegetation was 1.18 (IQR 0.82 to 1.30) cm. S. suis IE resulted in significant valvular regurgitation in 20 (80.0%) lesions. Furthermore, 10 patients (52.6%) had perivalvular complications from IE, with valvular perforation being the most common complication. There was one patient who had both valvular perforation and perivalvular abscess. The hospital length of stay in the IE group was longer than in the non-IE group (28.9 days (IQR 16–40 days) vs. 14.5 days (IQR 4–22 days)). 68.4% of the patients (13 out of 19) required valvular surgery (in-hospital surgery in 10 patients and elective surgery in 3 patients). There were no deaths in the IE groups and five deaths (9.6%) in the non-IE group (p = 0.315). All deaths occurred in-hospital with a median time to death 2 days (IQR 1–23 days). Four out of five (80%) died within 5 days of admission, pointing out the severity at the time of the presentation and delayed hospital referral.

Table 4

Echocardiographic features of Streptococcus suis infective endocarditis, n = 19
Site of valvular involvement ( 25 lesions )
Mitral valve	11/25 (44.0)
Aortic valve	13/25 (52.0)
Tricuspid valve	1/25 (4.0)
Presence of vegetation (24 lesions)	14/19 (73.7)
Size of vegetation (cm)	1.18 (0.82,1.3)
Regurgitation degree (25 lesions)
No	2/25 (8.0)
Mild	3/25 (12.0)
Moderate	2/25 (8.0)
Severe	18/25 (72.0)
Perivalvular complications (11 lesions, 10 patients)	10/19 (52.63)
Abscess	1/11 (9.1)
Pseudoaneurysm	0/11 (0.0)
Fistula	0/11(0.0)
Perforation	10/11 (90.9)

Data were expressed as number (percentage) or median (interquartile range)

We conducted the study of 71 patients admitted to Siriraj Hospital due to S. suis septicemia. The overall prevalence of S. suis IE in patients with S. suis septicemia was 26.8%, which was higher than those reported in the previous studies (6.4–25.6%).^(1,2,6) However, those studies included all patients with S. suis infection, unlike our study, which included only patients with S. suis septicemia. Furthermore, those studies did not mention the frequency of the patients that had echocardiography performed. Despite a higher prevalence of S. suis IE in our study than previous literature, we expected the underestimation of S. suis IE in our study since TTE was done in less than half (42.3%) of the patients and even less for TEE (9.8%). This may be due to lack of awareness of the organism’s invasiveness and our facility’s echocardiography availability.

Regarding the aggressiveness of S. suis IE, we found that this pathogen can highly destroy cardiac valves and perivalvular structures. Our present study has shown that 80.0% and 52.6% of S. suis IE patients had significant valvular regurgitation and perivalvular complications of IE, respectively. A total of 13 out of 19 patients underwent valvular surgery according to standard guideline.⁽⁸⁾ A study of S. suis IE from Trirattanapa et al.⁽⁴⁾ had a similar rate of significant valvular regurgitation (81.4%) and perivalvular complications (35%) to our present study, even though a higher rate of cardiac surgery was reported (81%). We believed that this may be due to the higher rate of systemic embolism (40.0%) in the latter study. When compared to the previous S. aureus report⁽⁹⁾, we found the prevalence of S. aureus IE in S. aureus septicemia was 22%, perivalvular complications and cardiac intervention were occurred in 23.0% and 64.2%, respectively. These outcomes were similar to our report. One would argue that in the S. aureus literature, IE was included only as “definite IE” regarding the modified Duke criteria, compared to our reports that definite IE by ESC clinical criteria was only diagnosed in 12 patients (63.2%). However, this is the different case since S .aureus was already classified as a “typical organism” (8, 10), but S. suis was not. This posed a difference in the daily routine clinical practice and vigilantness of primary physicians between these two organisms; therefore, the “IE blood drawing” protocol was far less utilized in S. suis IE. In our point of view, with S. suis septicemia and signs of IE/perivalvular complication by echocardiography would be appropriate enough to diagnose those patients as IE, whether definite or possible, and included them in the present study. Nonetheless, considering the recent update of 2023 Duke-International Society of Cardiovascular Infectious Diseases (ISCVID) criteria⁽¹⁰⁾, all streptococcus spp. (except streptococcus pneumoniae and streptococcus pyogenase) were added as typical organisms and the requirement for timing or separate venipuncture was removed. If this 2023 updated Duke-ISCVID criteria was applied to our report, it will reach definite clinical criteria for IE in 19 patients (100%). However, if we included both pathological and clinical criteria, our cohort would reach a definite IE in 94.7% (18 out of 19 patients) by the ESC criteria and 100% (19 out of 19 patients) by the 2023 updated Duke-ISCVID criteria. Given that, generally, not all suspected IE patients will undergo cardiac surgery and the pathologic criteria will never be sought out. Therefore, the ESC clinical criteria can only detect 63.2% of all IE patients. On the contrary, 2023 updated Duke-ISCVID clinical criteria can detect up to 100% of patients. This information highlighted the need to re-classify S. suis as a “typical” organism.

As for the predictors of S. suis IE in S. suis septicemia, after univariate analyses, we found that dyspnea, immunologic phenomena, new murmurs, and heart failure were all predictors of IE. Nevertheless, heart failure was the only independent predictor for S. suis IE with adjusted OR 35.61 (95%CI 3.24-390.44). This highlighted the group of patients who would benefit most if echocardiography were performed.

Other echocardiographic findings, including LVEDV, LVESV, LVDd, and LVDs, were significantly higher in those with IE. We believe that this points out to subacute nature of S. suis IE, which allowed the left ventricle to remodel, even though there was high valvular destruction. From a treatment perspective, patients with IE had twice the length of stay compared to the non-IE group. This finding may lead to more nosocomial complications, physical and psychological deterioration, and even economic issues for the patients. Fortunately, there were no deaths in our IE group when compared to a 6-month mortality rate of 26% in S. aureus IE⁽⁹⁾. This may be due to different antibiotic susceptibilities between organisms, advances in treatment, and the difference in prevalence of prosthetic valve IE.

In summary, the prevalence and aggressive nature of S. suis IE are comparable to those of S. aureus IE⁽⁹⁾, but there is still no recommendation for routine TTE surveillance for S. suis IE in patients with S. suis septicemia. We believe that this is due to the scarcity of S. suis IE studies compared to S. aureus, leading to underrecognized the invasiveness of this pathogen. We hope that our study might be one of the studies that may affect the change in clinical practice, and we further encourage reclassifying this pathogen as a “typical” pathogen in all future IE guidelines.

Limitations of the study

There are a few limitations of this study that needed to be mentioned. First, the study design was a retrospective cohort study. This inevitably led to confounding factors that could not be adjusted and might affect the outcomes of the study. Second, the sample size was small due to the low prevalence of S. suis septicemia, even though this is almost a 16-year cohort. Third, to find the true prevalence of S. suis IE in patients with S. suis septicemia, all patients should have echocardiography performed. However, this might not be possible for a single-centered study, as the incidence of S. suis septicemia is only 4 patients per year.

The prevalence of S. suis IE in patients with S. suis septicemia was 26.7%. This organism can cause valvular damage and perivalvular complications, resulting in heart failure and valvular surgery. By multivariate analysis, heart failure was an independent predictor of S. suis IE in S. suis septicemia patients. Therefore, echocardiography should be considered in all patients with S. suis septicemia, especially those with heart failure, due to the high prevalence and IE complications of this pathogen. Further re-classification of this pathogen to a “typical” organism should also be deliberated.

ESC; European Society of Cardiology

CI; confidence interval

IE; infective endocarditis

IQR; interquartile range

ISCVID; International Society of Cardiovascular Infectious Diseases

LVDd; left ventricular dimension during diastole

LVDs; left ventricular dimension during systole

LVEDV; left ventricular end diastolic volume

LVEF; left ventricular ejection fraction

LVESV; left ventricular end systolic volume

OR; odds ratio

S. aureus; Staphylococcus aureus

S. suis; Streptococcus suis

SD; standard deviation

TEE; transesophageal echocardiography

TTE; transthoracic echocardiography

Ethics approval and consent to participate

Our study was approved by Committee for Human research, Siriraj Hospital, Mahidol University. The Institutional Review Board (IRB) number is Si935/2023. According to retrospective and anonymous research, the IRB did not require inform consent from the patients.

Consent for application

Not applicable

Availability of data and materials

The data analyzed during the current study are not publicly available due to human data privacy’s law, but are available from the corresponding author on reasonable request.

Competing interests

The authors declare that they have no competing interests.

Funding

This manuscript did not receive funding.

Author’s contribution

PK (first author) was involved in designing the study, acquiring and analyzing the data, and writing the manuscript.

SJ (essentially intellectual contributor) was involved in designing the study, analyzing the data, giving advice, concluding, and writing the manuscript.

NR (corresponding author) was involved in designing the study, analyzing the data, giving advice, concluding, and revising the manuscript.

All authors read and approved the final manuscript.

Acknowledgements

Not applicable

Footnotes

Not applicable

Kerdsin A. Human streptococcus suis Infections in Thailand: Epidemiology, Clinical Features, Genotypes, and Susceptibility. Trop Med Infect Dis. 2022;7(11):359. https://doi.org/10.3390/tropicalmed7110359.
Rayanakorn A, Katip W, Hing Goh B, Oberdorfer P, Learn Han Lee LC, Manifestations. Risk Factors of Streptococcus suis Mortality Among Northern Thai Population: Retrospective 13-Year Cohort Study. Infect Drug Resist. 2019;12:3955–65. https://doi.org/10.2147/IDR.S233326.
Rayanakorn A, Ademi Z, Liew D, Han Lee L. Burden of disease and productivity impact of streptococcus suis infection in Thailand. PLoS Negl Trop Dis. 2021;15(1):e0008985. https://doi.org/10.1371/journal.pntd.0008985.
Trirattanapa K, Kaewpoowat Q, Kanjanavanit R. Streptococcus suis Endocarditis: Echocardiographic Features and Clinical Outcomes. Open Forum Infect Dis. 2021;8(Suppl 1):S446–7. https://doi.org/10.1093%2Fofid%2Fofab466.886.
Fongcom A, Pruksakorn S, Netsirisawan P, Pongprasert R, Onsibud P. Streptococcus suis infection: a prospective study in northern Thailand. Southeast Asian J Trop Med Public Health. 2009;40(3):511–7.
Huong VTL, Ha N, Huy NT, Horby P, Nghia HDT, Thiem DT, et al. Epidemiology, Clinical Manifestations, and Outcomes of Streptococcus Suis Infection in Human. Emerg Infect Dis. 2014;20(7):1105–14. https://doi.org/10.3201/eid2007.131594.
Pachirat O, Taksinachanekit S, Mootsikapun P, Kerdsin A. Human Streptococcus suis Endocarditis: Echocardiographic Features and Clinical Outcome. Clin Med Insights Cardiol. 2012;6:119–23. https://doi.org/10.3201/eid2007.131594.
Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, et al. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J. 2015;36:3075–128. https://doi.org/10.1093/eurheartj/ehv319.
Rasmussen RV, Høst U, Arpi M, Hassager C, Johansen HK, Korup E, et al. Prevalence of infective endocarditis in patients with Staphylococcus aureus bacteraemia: the value of screening with echocardiography. Eur J Echocardiogr. 2011;12:414–20. https://doi.org/10.1093/ejechocard/jer023.
Fowler VG, Durack DT, Selton-suty C, Athan E, Bayer AS, Chamis AL, et al. The 2023-Duke International Society for Cardiovascular Infectious Disease Criteria for Infective Endocarditis: Updating the Modified Duke Criteria. Clin Infect Dis. 2023;77(4):518–26. https://doi.org/10.1093/cid/ciad271.

No competing interests reported.

Download PDF

Journal Publication

published 14 Nov, 2024

Read the published version in BMC Infectious Diseases →

Editorial decision: Revision requested
10 Sep, 2024
Reviews received at journal
08 Sep, 2024
Reviews received at journal
31 Aug, 2024
Reviewers agreed at journal
27 Aug, 2024
Reviewers agreed at journal
16 Aug, 2024
Reviewers invited by journal
14 Aug, 2024
Editor invited by journal
13 Aug, 2024
Editor assigned by journal
12 Aug, 2024
Submission checks completed at journal
12 Aug, 2024
First submitted to journal
09 Aug, 2024

You are reading this latest preprint version

Streptococcus Suis Infective Endocarditis in Patients With Streptococcus Suis Septicemia : A Retrospective Study of Prevalence and Outcomes

Status:

Journal Publication

Version 1

Abstract

Background

Objective

Materials and method

Result

Conclusion

Figures

Introduction

Materials and methods

Study design and participants

Measurement and outcomes

Statistical analysis

Results

Discussion

Limitations of the study

Conclusion

Abbreviations

Declarations

References

Additional Declarations

Status:

Journal Publication

Version 1