Clinical Features and Outcomes of Streptococcus anginosus Group Infective Endocarditis: A Multicenter Matched Cohort Study

Abstract

Abstract Background Although Streptococcus anginosus group (SAG) endocarditis is considered a severe disease associated with abscess formation and embolic events, there is limited evidence to support this assumption. Methods We performed a retrospective analysis of prospectively collected data from consecutive patients with definite SAG endocarditis in 28 centers in Spain and Italy. A comparison between cases due to SAG endocarditis and viridans group streptococci (VGS) or Streptococcus gallolyticus group (SGG) was performed in a 1:2 matched analysis. Results Of 5336 consecutive cases of definite endocarditis, 72 (1.4%) were due to SAG and matched with 144 cases due to VGS/SGG. SAG endocarditis was community acquired in 64 (88.9%) cases and affected aortic native valve in 29 (40.3%). When comparing SAG and VGS/SGG endocarditis, no significant differences were found in septic shock (8.3% vs 3.5%, P\u2005=\u2005.116); valve disorder, including perforation (22.2% vs 18.1%, P\u2005=\u2005.584), pseudoaneurysm (16.7% vs 8.3%, P\u2005=\u2005.108), or prosthesis dehiscence (1.4% vs 6.3%, P\u2005=\u2005.170); paravalvular complications, including abscess (25% vs 18.8%, P\u2005=\u2005.264) and intracardiac fistula (5.6% vs 3.5%, P\u2005=\u2005.485); heart failure (34.7% vs 38.9%, P\u2005=\u2005.655); or embolic events (41.7% vs 32.6%, P\u2005=\u2005.248). Indications for surgery (70.8% vs 70.8%; P\u2005=\u20051) and mortality (13.9% vs 16.7%; P\u2005=\u2005.741) were similar between groups. Conclusions SAG endocarditis is an infrequent but serious condition that presents a prognosis similar to that of VGS/SGG.