Left-sided infective endocarditis caused by Streptococcus agalactiae: rare and serious

  • Radka Ivanova-GeorgievaEmail author
  • Josefa Ruiz-Morales
  • Emilio García-Cabrera
  • María Victoria García-López
  • Juan Gálvez-Acebal
  • Antonio Plata-Ciezar
  • Javier de la Torre Lima
  • Carmen Hidalgo-Tenorio
  • Francisco Javier Martínez-Marcos
  • David Vinuesa García
  • Rafael Luque
  • Arístides de Alarcón González
Original Article


A comparative study of the behaviour of left-sided infective endocarditis (left-sided IE) due to Streptococcus agalactiae (GBS) with left-sided IE caused by Staphylococcus aureus (SA). A prospective, multicentre cohort study in eight public hospitals in Spain, from January 1984 to December 2015; comparative analysis and factors associated with mortality. In total, there were 1754 episodes of left-sided IE; 41 (2.3%) caused by GBS vs. 344 (19.6%) due to SA, definitive IE 39 vs. 324 cases, males, 25 vs. 213, respectively. There were no differences in age or comorbidity, and healthcare-associated acquirement was 10% vs. 43%, p 0.001. Transthoracic echocardiogram (TTE) was performed in 95% vs. 96.8% and a transesophageal echocardiogram (TEE) in 61% vs. 56%. Vegetations were detected in 80% and measured > 1 cm in a similar proportion. It affected native valves in 85.4% vs. 82.6% and late prosthetic valve in 14.6% vs. 9.6%. The course was acute in both groups. There were more skin manifestations in SA left-sided IE, 7.3% vs. 32%, p 0.001. Both groups had similar complications, but in SA, there was more renal failure, 24% vs. 45%, p 0.010. Surgical risk and operated patients were similar. Mortality was proportionally higher in the SA group, without significance 29% vs. 43% (150), p 0.09. Heart failure, septic shock and neurological deterioration conditioned mortality: HR 1.96, 1.69 and 1.37 (CI 95% 1.40–2.73; 1.19–2.39 and 0.99–1.88 respectively) and to a lesser degree SA as aetiology agent and age. Left-sided IE caused by GBS is similar in severity to left-sided IE caused by SA.


Left-sided infective endocarditis Streptococcus agalactiae Staphylococcus aureus 


Compliance with ethical standards

All procedures followed were in accordance with the ethical standards. Informed consent was obtained from all patients for being included in the study.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Radka Ivanova-Georgieva
    • 1
    Email author
  • Josefa Ruiz-Morales
    • 2
  • Emilio García-Cabrera
    • 3
  • María Victoria García-López
    • 4
  • Juan Gálvez-Acebal
    • 5
  • Antonio Plata-Ciezar
    • 6
  • Javier de la Torre Lima
    • 7
  • Carmen Hidalgo-Tenorio
    • 8
  • Francisco Javier Martínez-Marcos
    • 9
  • David Vinuesa García
    • 10
  • Rafael Luque
    • 11
  • Arístides de Alarcón González
    • 11
  1. 1.Servicio de Medicina Interna, Instituto de Investigación Biomédica de Málaga (IBIMA)Hospital Clínico Universitario “Virgen de la Victoria”MálagaSpain
  2. 2.UGC de Enfermedades Infecciosas, Instituto de Investigación Biomédica de Málaga (IBIMA)Hospital Clínico Universitario “Virgen de la Victoria”MálagaSpain
  3. 3.Delos Clinical Clinical Research OrganizationSevilleSpain
  4. 4.Servicio de Microbiologia Clínica, Instituto de Investigación Biomédica de Málaga (IBIMA)Hospital Clínico Universitario “Virgen de la Victoria”MálagaSpain
  5. 5.UGC de Enfermedades Infecciosas, Instituto de Biomedicina de Sevilla, IBiSHospital Universitario Virgen Macarena. CSIC, Universidad de SevillaSevilleSpain
  6. 6.Servicio de Enfermedades InfecciosasHospital Regional Universitario de MálagaMálagaSpain
  7. 7.Grupo de Enfermedades Infecciosas de la Unidad de Medicina InternaHospital Costa del Sol. MarbellaMálagaSpain
  8. 8.UGC de Enfermedades InfecciosasHospital Universitario Virgen de las Nieves, Complejo Hospitalario Universitario de GranadaGranadaSpain
  9. 9.UGC de Enfermedades InfecciosasComplejo Hospitalario Universitario de HuelvaHuelvaSpain
  10. 10.Servicio de Medicina Interna-Enfermedades InfecciosasHospital Clínico San Cecilio-CHUGGranadaSpain
  11. 11.UGC de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Servicio de E. Infecciosas, Instituto de Biomedicina de Sevilla (IBiS)Hospital Universitario Virgen del RocíoSevilleSpain

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