Non-betahemolytic streptococcal bacteremia, cardiac implantable electronic device, endocarditis, extraction, and outcome; a population- based retrospective cohort study

Non-betahemolytic streptococcal bacteremia, cardiac implantable electronic device, endocarditis, extraction, and outcome; a population- based retrospective cohort study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Non-betahemolytic streptococcal bacteremia, cardiac implantable electronic device, endocarditis, extraction, and outcome; a population- based retrospective cohort study Andreas Berge, Johannes Lundin, Anna Bläckberg, Torgny Sunnerhagen, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3615135/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 18 Apr, 2024 Read the published version in Infection → Version 1 posted 8 You are reading this latest preprint version Abstract Purpose Patients with non-beta-hemolytic streptococcal bacteremia (NBHSB) are at risk of infective endocarditis (IE). Patients with cardiac implantable electronic device (CIED) have been described to have an increased risk of IE. The aim of the study was to describe a population-based cohort of patients with NBHSB and CIED and variables associated with IE and recurrent NBHSB. Methods All episodes with NBHSB in blood culture from 2015 to 2018 in a population of 1.3 million inhabitants were collected from the Clinical Microbiology Laboratory, Lund, Sweden. Through medical records, patients with CIED during NBHSB were identified and clinical data were collected. Patients were followed 365 days after NBHSB. Results Eighty-five episodes in 79 patients with CIED and NBHSB constituted the cohort. Eight patients (10%) were diagnosed with definite IE during the first episode, five of whom also had heart valve prosthesis (HVP). In 39 patients (49%) transesophageal echocardiography (TEE) was performed of which six indicated IE. Four patients had the CIED extracted. Twenty-four patients did not survive (30%) the study period. Four patients had a recurrent infection with NBHSB with the same species, three of whom had HVP and had been evaluated with TEE with a negative result during the first episode and diagnosed with IE during the recurrency. Conclusion The study did not find a high risk of IE in patients with NBHSB and CIED. Most cases of IE were in conjunction with a simultaneous HVP. A management algorithm is suggested. Non-beta-hemolytic Streptococcus bacteremia endocarditis CIED extraction and recurrent infection Figures Figure 1 Figure 2 Introduction Infective endocarditis (IE) is a life-threatening infection, demanding long antibiotic treatment and, under some circumstances, thoracic surgery or other interventions ( 1 ). IE can be caused by a plethora of different bacteria ( 1 ). The most common causative agents are Staphylococcus aureus, Enterococcus faecalis , and non-beta hemolytic streptococci (NBHS), together constituting the responsible agent for approximately 70% of the IE cases diagnosed ( 2 – 4 ). In clinical practice, a positive blood culture (BC) with any of these bacteria, or other prone to cause IE, is often the first observation indicating that a patient has an IE. Cardiac implantable electronic devices (CIEDs) are increasingly used to treat various conditions ( 5 ). In the circumstances with bacteremia in a patient with a CIED, an increased risk of IE has been described and a reduced risk of treatment failure has been associated with the extraction of the CIED, why extraction is recommended in cases of CIED IE ( 6 ). However, these recommendations are derived from studies of S. aureus IE or from tertiary referral centers ( 7 , 8 ). In one study of NBHS bacteremia (NBHSB), CIED was not found to be significantly associated to IE, and thus not included in the HANDOC score, designed to assess the risk of IE in patients with NBHSB ( 9 ). In a large study of streptococcal blood stream infections by Chamat-Hedemand et al. , CIED was found to be a significant risk factor for IE (odds ratio 1.7) ( 10 ), but the exact risk of IE in the group of patients with CIED and NBHSB was not addressed. In a recent publication on NBHSB and risk factors for IE, CIED was significantly associated with IE in univariable analysis but in multivariable analysis no correlation was seen, likely due to the covariation with other risk factors ( 11 ). The risk of IE has been shown to be very different between different NBHS groups and species ( 9 , 10 ). However, the nomenclature and taxonomy of the NBHS are complicated and misunderstandings are common, why a comparison of the results of different studies has been impaired. The aims of this study were to describe a population-based cohort of patients with CIED and NBHSB, the rate of IE and recurrent infection, identify variables associated to IE, and to describe the clinical presentation of the recurrent infections. We also aimed to suggest how this complicated clinical situation can be managed. Material and methods The cohort Information on all consecutive BCs positive for NBHSfrom January 2015 to December 2018, were obtained from the laboratory databases of Clinical Microbiology, Region Skåne, Lund, Sweden, the only laboratory in the region, with a catchment area population of 1.36 million inhabitants in 2018. All medical records of patients older than 18 years were studied retrospectively and patients with CIED at place at the time of the bacteremia constituted the study cohort. From these patients, detailed information was collected and stored in accordance with the ethical approval obtained from the Swedish Ethics Committee (2020-00314). Data were collected by JL and were validated by MR and AB. Definitions The definitions of IE and CIED infection were used according to the European Society of Cardiology (ESC) criteria by Habib et al. (12). In the last analysis in the result section the European Heart Rhythm Association (EHRA) diagnostic criteria from Blomström-Lundqvist et al .(6), ESC 2023 guidelines diagnostic criteria (1), and the Duke-International Society for Cardiovascular Infectious Diseases (ISCVID) criteria (13). The minor criterium predisposition to IE was used according to Dajani et al. (14), and in the comparison of the different diagnostic criteria systems, with the modifications described in the respective system. All changes seen on TTE or TEE, indicating IE, was considered to be caused by infection due to the difficulty to differentiate from changes due to other causes (15) and the assumed high pretest probability for CIED IE in this cohort. All infections fulfilling the criteria for definite IE were referred to as CIED IE irrespective whether changes were found on the CIED or heart valves (6). An episode of NBHSB was defined by the start of the clinical symptoms or signs in a patient resulting in blood culture taken, showing growth of NBHS. An episode was delimited by at least seven days of effective treatment and clinical improvement or, if not fulfilled, after 30 days. A later clinical condition resulting in a BC being taken with growth of NBHS, of the same species as in the first episode, within the study period of 365 days, was referred to as a “recurrent infection” or “recurrence” and was not included in the study as a first or primary episode in tables 1-3. The expression “recurrent infection” or “recurrence” was used in this study since it cannot be determined whether the infection was caused by the same bacterium, indicating relapse, or by another NBHS clone indicating a reinfection. The primary endpoint was definite IE. A secondary endpoint was recurrent infection with the same species of NBHS during the observation period. Origin of infection and other focal infections caused by NBHS were defined as described (16). Comorbidities were retrieved from registrations in the medical records prior to the episode and classified according to the Charlson index modified by Quan et al. (17, 18). The HANDOC scores were calculated as described (9). Microbiology During the study period guidelines recommended that two sets of blood culture bottles (aerobic and anaerobic) should be taken from two separate venipunctures. The blood culture system in use was BACTEC FX (BectonDickinson, Franklin Lakes, United States), using a 5-day incubation unless otherwise requested. The main method for species determination was matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS: Bruker Daltonics, using the Bruker MBT Compass library version most recent at the time of sample analysis), with a PCR and 16S sequencing using the Sanger method as a second line method for selected hard-to-identify isolates. Species designations were used according to the 2022 International Code of Nomenclature of Prokaryotes (ICPN) and the List of Prokaryotic names with Standing in Nomenclature (LPSN) (19, 20). The grouping of streptococcal species into the S. mitis group, S. anginosus group, S. sanguinis group, S. salivarius group, S. mutans group, and S. bovis group was done in concordance with previous publications (9, 21-23). Data collection and analysis The collection of the microbiological and clinical data of an episode was from 365 days before its start until 365 days after the first positive BC during that episode. The collected variables are listed in the Supplementary material. The number of CIED carriers in the Region was taken from the Swedish Pacemaker and Implantable Cardioverter-Defibrillator Registry. The analysis of the collected data was conducted in Stata, version 15.1 (StataCorp, College Station, TX, USA). To describe the differences in dichotomous variables the χ 2 test was used and if the prerequisites were not met, the p- value of Fisher’s exact test was used. Differences between continuous variables were analyzed with Wilcoxon’s rank-sum test as normal distribution was not assumed. Values are presented as proportions or medians with interquartile ranges (IQR). Results The cohort The data extraction from the laboratory resulted in 1637 episodes of NBHSB in the four-year study period (2015-2018). In 79 patients with 85 episodes, a CIED was found at place at the time for the bacteremia. During the study period, the average number of persons with CIED and population in the region, was 8869 and 1 315 000, respectively, giving an incidence of 0.22 NBHSB/1000 CIED/year. The first episode in each patient was further studied and accounted for in tables 1-3. The six episodes of recurrent infections are described in table 4. Definite IE was diagnosed during eight of the primary episodes and the CIED was extracted during four episodes. No recurrent infections were diagnosed during the observation time after the IE episodes. The 71 episodes not diagnosed with definite IE, were followed by a recurrent episode in four patients, and IE was diagnosed in three of these patients during the recurrences (Figure 1). Variables associated with IE For the first episodes in the patients of the cohort, clinical variables are presented using univariable analysis to identify variables associated with IE (Table 1). Community acquisition was more common in the IE group. Predisposition and one of its components, HVP, and a BC fulfilling the major criterion for IE were significantly more common among patients diagnosed with IE. Both the HANDOC score as a continuous variable and the positive HANDOC score with the stipulated cut off of ≥3 points were significantly associated with IE. In table 2, the distribution of IE and non-IE episodes, between the different groups constituting the NBHS are described. The group of patients with S. mutans bacteremia had two episodes of IE out of three episodes and none of the 16 episodes of S. anginosus bacteremia had IE. The distribution was significantly different from the one expected by chance, p -value 0.047 (Table 2). Management and outcome The management and outcome of the patients in the 79 episodes are described (Table 3) using univariable analysis. In 56 episodes (71%) an echocardiography was performed, 39 patients (49%) were examined with TEE. Four patients were evaluated with PET-CT, out of which one was indicative of IE. No cardiac CT was performed. In 62 episodes a total of 83 examinations (51 radiology of the lungs, 13 CT of the lungs, and 19 CT of the abdomen) were performed to identify embolic events. Of these, two indicated embolization. The CIED was extracted in four patients, all with changes visualized on the CIED, and two fulfilling the criteria for definite IE. No patient had a positive culture from an extracted CIED and in one patient, the 16S analysis confirmed the BC result. The one-year overall mortality in the entire cohort was 30%. The comparison between patients diagnosed with definite IE and without the diagnosis demonstrated significant differences in the rate of echocardiography performed, the rate of extraction, and the treatment time (Table 3). No significant differences were seen in recurrences or mortality. The recurrent infections In the four episodes followed by a recurrent NBHSB, three of the patients had a HVP and in the same three TEE, but not PET-CT, was performed during the first episode (Table 4). No focal infection was diagnosed in any of the four patients and the patients were treated with antibiotics for 2, 10, 15, and 15 days, respectively. The patients had positive BC with the same group of NHBS in both episodes. Two of the patients with recurrence had bacteremia with the S. bovis group, one with S. salivarius , and one with the S. mitis group. The three patients with the HVP were all diagnosed to have an IE during the recurrency. Two of the patients had the major structural criterion by a positive TEE and one had a PET-CT showing IE. None of the recurrent infections had visible changes on the CIED. Two of the were subjected to surgery and one died during the treatment but 54 days after the second episode (Table 4). Alternative diagnostic criteria systems In this study, the diagnostic criteria of ESC 2015 was used (12). A comparison with three other diagnostic criteria systems is described in Table 5. The ESC 2015 and EHRA 2020 result in the same distribution of definite, possible, and rejected IE. The results of the ESC 2023 and the Duke-ISCVID diagnostic criteria systems result in the same distribution of classification of IE but differs from the former, as one additional episode was classified as definite IE and four episodes were reclassified from rejected IE to possible IE (Table 5). Discussion The main finding in this study is that IE is found in 10% of a population-based cohort of patients with CIED and NBHSB and extraction of the CIED was not performed unconditionally in cases of CIED IE. Further, a low rate of recurrent infections (5%) was encountered. Finally, three patients were diagnosed with IE during the recurrent infections, all related to an HVP. The role of CIED in the pathogenesis of IE is debated. Whether CIED is a risk factor for IE, most likely depends on the species of the causing bacterium. In studies of patients with S. aureus bacteremia it was demonstrated that CIED was a risk factor for IE ( 7 , 24 ) while in Enterococcus faecalis bacteremia, the presence of a CIED was not shown to be associated with IE ( 16 ). In a previous study of NBHSB ( 9 ), CIED was not significantly associated with IE (but with a p -value close to 0.05). In that study CIED covaried with HVP, which was shown to predict IE (unpublished data). In another NBHSB and IE study, CIED was associated to IE in univariable analysis but in multivariable analysis, an odds ratio of 0.66 was found ( 11 ). Chamat-Hedemand et al. described a large cohort of patients with patients with CIED and NBHSB but in the calculation resulting in CIED being a significant risk factor for IE, the patients with bacteremia with species addressed in this study only constitute a minority (approximately 30%). In two alternative IE diagnostic criteria systems ( 1 , 13 ), CIED is included among the different conditions constituting the predisposition minor criterium, resulting in that all patients in this cohort have that minor criterion. This change in the diagnostic criteria did not result in any profound differences in the rates of definite and possible IE. The data presented in this study neither indicate CIED to be a strong risk factor for IE in NBHSB nor contributes to result in a better performance for the diagnostic criteria if introduced as a minor criterion. The results of this study were in line with the findings in several studies ( 9 , 21 , 25 ), showing that the risk of IE was diverse between groups of NBHS. S. sanguinis, S. bovis , and S. mutans are prone to cause IE, S. mitis and S. salivarius are connected to an intermediate risk, and S anginosus is unlikely to cause IE. In only four patients (5%) in the entire cohort, the CIED was extracted and in patients fulfilling the criteria for definite IE, two out of 8 (25%) of the patients had the CIED extracted. None of the patients with IE had a recurrent infection that would indicate treatment failure. The guidelines recommend extraction of the CIED in cases diagnosed with CIED infection or CIED IE ( 6 ) but this was not performed in our cohort, challenging the necessity to follow the recommendations. Four out of 71 patients (6%) not diagnosed with IE had a recurrent infection with NBHSB, and none was found to have CIED changes. However, three patients had suspected missed left sided HVP IE. Although beyond the scope of this study, the three missed HVP IE with recurrent infections illustrate the importance of continuing the evaluation of a patient with HVP, NBHSB, and a negative TEE. Such patients could be subjected to PET-CT, cardiac CT, repeated TEE, or followed clinically for early detection of relapse ( 6 , 12 , 13 ). Based on our results, we suggest a management strategy that includes that all patients should be evaluated with TEE and, if negative, a PET-CT or possibly cardiac CT could be considered if the suspicion of CIED IE remains. The size of our study does not permit us to identify specific risk factors for IE in patients with CIED and thus the HANDOC score is suggested to be used to direct the management after a negative TEE. None of the diagnosed episodes of definite IE, nor any of the patients with a recurrent infection, had a negative HANDOC-score. Thus, we propose that the risk of IE would be negligible with both a negative TEE and a negative HANDOC score and further evaluation for IE could be omitted (Fig. 2 ). Another line of inquiry would be to test the hypothesis that TEE can be omitted in patients with CIED, NBHSB, and a negative HANDOC score. However, this suggestion has to be tested in future prospective studies. Although this is the largest study cohort focusing on CIED-carrying patients with NBHSB, it has obvious limitations. The retrospective design and the far from complete evaluation using TEE (49%), make it possible that some patients with changes on the CIED could have been missed. Moreover, only four patients were subjected to PET-CT, also possibly contributing to under-diagnosis. Furthermore, despite the long follow up and thorough evaluation of the medical records, some patients could have died of an undiagnosed IE, another undiagnosed NBHS infection, or a recurrent infection. Finally, we do not know if the recurrent infections were true relapses or reinfection with another clone from the same group NBHS. Despite the shortcomings, we believe that the observation of low frequency of CIED infections in NBHSB and the suggestion of a management algorithm has implications for the management of the patients. Declarations Funding: The work was supported by the Swedish Government Fund for Clinical Research (ALF) and the foundations of Österlund and Skåne University Hospital to MR. Author Contribution All authors have seen and approved the manuscript, contributed significantly to the work, and the manuscript has not been previously published nor is not being considered for publication elsewhere. References Delgado V, Ajmone Marsan N, de Waha S, Bonaros N, Brida M, Burri H, et al. 2023 ESC Guidelines for the management of endocarditis: Developed by the task force on the management of endocarditis of the European Society of Cardiology (ESC) Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS) and the European Association of Nuclear Medicine (EANM). European Heart Journal. 2023. Baddour LM, Shafiyi A, Lahr BD, Anavekar NS, Steckelberg JM, Wilson WR, et al. A Contemporary Population-Based Profile of Infective Endocarditis Using the Expanded Rochester Epidemiology Project. Mayo Clin Proc. 2021;96(6):1438-45. Pant S, Patel NJ, Deshmukh A, Golwala H, Patel N, Badheka A, et al. Trends in infective endocarditis incidence, microbiology, and valve replacement in the United States from 2000 to 2011. J Am Coll Cardiol. 2015;65(19):2070-6. Noubiap JJ, Nkeck JR, Kwondom BS, Nyaga UF. Epidemiology of infective endocarditis in Africa: a systematic review and meta-analysis. Lancet Glob Health. 2022;10(1):e77-e86. Priori SG, Blomström-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, et al. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Eur Heart J. 2015;36(41):2793-867. Blomström-Lundqvist C, Traykov V, Erba PA, Burri H, Nielsen JC, Bongiorni MG, et al. European Heart Rhythm Association (EHRA) international consensus document on how to prevent, diagnose, and treat cardiac implantable electronic device infections-endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), the Latin American Heart Rhythm Society (LAHRS), International Society for Cardiovascular Infectious Diseases (ISCVID) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Europace. 2020;22(4):515-49. Palraj BR, Baddour LM, Hess EP, Steckelberg JM, Wilson WR, Lahr BD, Sohail MR. 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. Sohail MR, Palraj BR, Khalid S, Uslan DZ, Al-Saffar F, Friedman PA, et al. Predicting risk of endovascular device infection in patients with Staphylococcus aureus bacteremia (PREDICT-SAB). Circ Arrhythm Electrophysiol. 2015;8(1):137-44. 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. Clinical Infectious Diseases. 2018;66(5):693-8. Chamat-Hedemand S, Dahl A, Østergaard L, Arpi M, Fosbøl E, Boel J, et al. Prevalence of Infective Endocarditis in Streptococcal Bloodstream Infections Is Dependent on Streptococcal Species. Circulation. 2020;142(8):720-30. Seo H, Hyun J, Kim H, Park S, Chung H, Bae S, et al. Risk and Outcome of Infective Endocarditis in Streptococcal Bloodstream Infections according to Streptococcal Species. Microbiol Spectr. 2023;11(4):e0104923. 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(44):3075-128. Fowler VG, Durack DT, Selton-Suty C, Athan E, Bayer AS, Chamis AL, et al. The 2023 Duke-ISCVID Criteria for Infective Endocarditis: Updating the Modified Duke Criteria. Clin Infect Dis. 2023. Dajani AS, Bisno AL, Chung KJ, Durack DT, Freed M, Gerber MA, et al. Prevention of bacterial endocarditis. Recommendations by the American Heart Association. JAMA. 1990;264(22):2919-22. George MP, Esquer Garrigos Z, Vijayvargiya P, Anavekar NS, Luis SA, Wilson WR, et al. Discriminative Ability and Reliability of Transesophageal Echocardiography in Characterizing Cases of Cardiac Device-Lead Vegetations versus Non-Infectious Echodensities. Clin Infect Dis. 2020. Berge A, Krantz A, Ostlund H, Naucler 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. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-83. Quan H, Li B, Couris CM, Fushimi K, Graham P, Hider P, et al. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol. 2011;173(6):676-82. Parte AC, Sarda Carbasse J, Meier-Kolthoff JP, Reimer LC, Goker M. List of Prokaryotic names with Standing in Nomenclature (LPSN) moves to the DSMZ. Int J Syst Evol Microbiol. 2020;70(11):5607-12. Oren A, Arahal DR, Goker M, Moore ERB, Rossello-Mora R, Sutcliffe IC. International Code of Nomenclature of Prokaryotes. Prokaryotic Code (2022 Revision). Int J Syst Evol Microbiol. 2023;73(5a). 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. Infectious Diseases. 2020;52(1):54-7. Poyart C, Quesne G, Trieu-Cuot P. Taxonomic dissection of the Streptococcus bovis group by analysis of manganese-dependent superoxide dismutase gene (sodA) sequences: reclassification of 'Streptococcus infantarius subsp. coli' as Streptococcus lutetiensis sp. nov. and of Streptococcus bovis biotype 11.2 as Streptococcus pasteurianus sp. nov. Int J Syst Evol Microbiol. 2002;52(Pt 4):1247-55. Richards VP, Palmer SR, Pavinski Bitar PD, Qin X, Weinstock GM, Highlander SK, et al. Phylogenomics and the dynamic genome evolution of the genus Streptococcus. Genome Biol Evol. 2014;6(4):741-53. Tubiana S, Duval X, Alla F, Selton-Suty C, Tattevin P, Delahaye 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):544-53. Plainvert C, Matuschek E, Dmytruk N, Gaillard M, Frigo A, Ballaa Y, et al. Microbiological Epidemiology of Invasive Infections Due to Non-Beta-Hemolytic Streptococci, France, 2021. Microbiol Spectr. 2023;11(3):e0016023. Friedman ND, Kaye KS, Stout JE, McGarry SA, Trivette SL, Briggs JP, et al. Health care--associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections. Ann Intern Med. 2002;137(10):791-7. Li JS, Sexton DJ, Mick N, Nettles R, Fowler VG, Jr., Ryan T, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis. 2000;30(4):633-8. Bizzini A, Durussel C, Bille J, Greub G, Prod'hom G. Performance of matrix-assisted laser desorption ionization-time of flight mass spectrometry for identification of bacterial strains routinely isolated in a clinical microbiology laboratory. J Clin Microbiol. 2010;48(5):1549-54. Sonesson A, Öqvist B, Hagstam P, Björkman-Burtscher IM, Miörner H, Petersson AC. An immunosuppressed patient with systemic vasculitis suffering from cerebral abscesses due to Nocardia farcinica identified by 16S rRNA gene universal PCR. Nephrol Dial Transplant. 2004;19(11):2896-900. Tables Table 1. Background and presentation of the patients with CIED and NBHSB. Characteristics All (n=79) (%) Episodes with definite IE (n=8) (%) Episodes without definite IE (n=71) (%) P -value Age (years) 84 (76-88) 84 (70-87) 84 (76-88) 0.81 Sex (female) 18 (23) 2 (25) 16 (23) 1.00 Charlson score 2 (1-4) 2 (1-4) 2 (1-4) 0.81 Acquisition: 0.046 Community 40 (51) 7 (88) 33 (46) 0.06 Health care associated 27 (34) 1 (12) 26 (37) 0.25 Nosocomial 12 (17) 0 (0) 12 (15) 0.35 CIED implantation (years) 5 (3-8) 6 (4-8) 5 (2-8) 0.27 Type of CIED: 1.00 PPM 69 (87) 7 (88) 62 (87) ICD 10 (13) 1 (12) 9 (13) Predisposition, any 24 (31) 6 (75) 18 (26) 0.01 Cardiac predisposition 24 (19) 6 (75) 18 (26) 0.01 Native valve disease 9 (11) 1 (12) 8 (11) 1.00 Prosthetic heart valve 15 (14) 5 (62) 10 (14) 0.005 Previous endocarditis 2 (3) 0 (0) 2 (3) 1.00 Intravenous drug user 0 (0) 0 (0) 0 (0) 1.00 Heart murmur or valve disease 27 (34) 6 (75) 21 (27) 0.97 Fever ≥38 degrees 62 (78) 5 (62) 57 (80) 0.36 Embolization 1 (1) 0 (0) 1 (1) 1.00 BC major criterion for IE 42 (53) 8 (100) 34 (48) 0.006 Time to positive BC (hours) 18 (11-29) 17 (13-22) 18 (11-30) 0.55 SOFA score (≥2 points) 32 (41) 4 (50) 28 (39) 0.71 Known origin of infection 22 (28) 1 (12) 21 (30) 0.67 Pocket infection 1 (1) 0 (0) 1 (1) Other origin of infections 1 21 (27) 0 (0) 21 (30) Unknown origin of infection 57 (72) 7 (88) 50 (70) 0.43 Duration of symptoms (days) 3 (1-6) 4 (2-22) 2 (1-6) 0.13 HANDOC score (points) 2 (1-4) 5 (4-5) 1 (2-4) <0.001 Positive HANDOC score (≥3 points) 34 (43) 8 (100) 26 (37) 0.001 Footnote: Univariable analysis of differences between patients diagnosed with definite IE and patients without definite IE. Values are given as numbers and proportions (%) and for continuous variables as medians and IQR. The p -value of differences in continuous variable were calculated with Wilcoxon’s rank sum test. In categorical variables, the differences were calculated using the χ 2 test when applicable and Fisher’s exact test in other cases. Differences with a p –value of <0.05 are considered significant and are shown in bold. 1 Most common focal infections were: abdominal focus: 10 patients, pneumonia: 3 patients, urinary tract infection: 2 patients, and oral infection: 2 patients. Table 2. BC results from the cohort of patients with CIED and NBHSB. BC results All (n=79) (%) Episodes with definite IE (n=8) (%) Episodes without definite IE (n=71) (%) P -value All NBHS BC results: 0.047 S. mitis group 29 (37) 3 (38) 26 (37) 1.00 S. sanguinis group 2 (3) 0 (0) 2 (3) 1.00 S. bovis group 17 (22) 2 (25) 15 (21) 1.00 S. anginosus group 16 (20) 0 (0) 16 (23) 0.20 S. mutans group 3 (4) 2 (25) 1 (1) 0.03 S. salivarius group 11 (14) 1 (12) 10 (14) 1.00 Other NBHS 1 (1) 0 (0) 1 (1) 1.00 Footnote: Univariable logistic regression of differences between patients diagnosed with definite IE and patients without definite IE. Values are given as numbers and proportions (%). The p -value of differences were calculated using the χ 2 test when applicable and Fisher’s exact test in other cases. Differences with a p –value of <0.05 are considered significant and are shown in bold. Table 3. Management and outcome of the patients with CIED and NBHSB. Characteristics All (n=79) (%) Episodes with definite IE (n=8) (%) Episodes without definite IE (n=71) (%) P -value Management TTE performed 54 (68) 8 (100) 46 (65) 0.051 Positive for IE 4 (5) 3 (38) 1 (1) TOE performed 39 (49) 7 (88) 32 (45) 0.029 Positive for IE 8 (10) 6 (75) 2 (3) <0.001 CIED changes 5 (6) 3 (38) 2 (3) 0.006 PET-CT performed 4 (5) 1 (12) 3 (4) 0.35 Positive for IE 1 (1) 1 (12) 0 (0) 0.10 CIED changes 0 (0) 0 (0) 0 (0) 1.00 Extraction of CIED 4 (3) 2 (25) 2 (3) 0.049 Treatment, total, (days) 13 (10-21) 28 (22-29) 13 (10-18) <0.001 Outcome Recurrence in NBHSB 4 (5) 0 (0) 4 (6) 1.0 Diagnosed with IE 3 (4) 0 (0) 3 (75) 1.0 Death within 30 days 14 (18) 1 (12) 13 (18) 1.00 Death within 365 days 24 (30) 3 (38) 21 (30) 0.69 Footnote: Univariable analysis of differences between patients diagnosed with definite IE and patients without definite IE. Values are given as numbers and proportions (%) and for continuous variables as medians and IQR. The p -value of differences in continuous variable were calculated with Wilcoxon’s rank sum test. In categorical variables, the differences were calculated using the χ 2 test when applicable and Fisher’s exact test in other cases. Differences with a p –value of <0.05 are considered significant and are shown in bold. Table 4. The clinical presentation of the patient with the recurrent episodes of NBHSB Footnote: U: unknown focus, IE: endocarditis, +: positive finding. 1 End of antibiotic therapy. 2 Three recurrent episodes, extraction of CIED and heart surgery during the third after positive PET-CT; last episode without known focus. Table 5. The outcome of four different diagnostic criteria systems Patients, n=79 ESC 2015 EHRA 2020 ESC 2023 Duke-ISCVID 2023 Definite IE 8 8 9 9 Possible IE 39 39 42 42 Rejected IE 33 33 28 28 Footnote: The diagnostic criteria systems have been abbreviated: ESC 2015 (12), EHRA 2020 (6), Duke-ISCVID 2023 (13), and the ESC 2023 (1). The ESC 2015 diagnostic criteria were used in this study. Additional Declarations No competing interests reported. Supplementary Files Supplementarymaterial.docx Cite Share Download PDF Status: Published Journal Publication published 18 Apr, 2024 Read the published version in Infection → Version 1 posted Editorial decision: Revision requested 22 Jan, 2024 Reviews received at journal 13 Jan, 2024 Reviews received at journal 03 Dec, 2023 Reviewers agreed at journal 23 Nov, 2023 Reviewers invited by journal 20 Nov, 2023 Editor assigned by journal 15 Nov, 2023 Submission checks completed at journal 15 Nov, 2023 First submitted to journal 15 Nov, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3615135","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":249634388,"identity":"e2f41eee-9257-4e48-917d-280025f059c1","order_by":0,"name":"Andreas Berge","email":"data:image/png;base64,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","orcid":"","institution":"Karolinska Institutet","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Andreas","middleName":"","lastName":"Berge","suffix":""},{"id":249634390,"identity":"83775cde-44b7-46fe-b0ca-f0e07368130f","order_by":1,"name":"Johannes Lundin","email":"","orcid":"","institution":"Lund University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Johannes","middleName":"","lastName":"Lundin","suffix":""},{"id":249634392,"identity":"f3b3b62e-1a01-477d-8530-60eac28d1031","order_by":2,"name":"Anna Bläckberg","email":"","orcid":"","institution":"Lund University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Anna","middleName":"","lastName":"Bläckberg","suffix":""},{"id":249634394,"identity":"0bdb98e0-6f49-4a81-9282-07604a59cf3c","order_by":3,"name":"Torgny Sunnerhagen","email":"","orcid":"","institution":"Lund University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Torgny","middleName":"","lastName":"Sunnerhagen","suffix":""},{"id":249634395,"identity":"c0c72064-cf84-4301-99f7-4a70a9a95b52","order_by":4,"name":"Magnus Rasmussen","email":"","orcid":"","institution":"Lund University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Magnus","middleName":"","lastName":"Rasmussen","suffix":""}],"badges":[],"createdAt":"2023-11-15 12:29:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3615135/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3615135/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s15010-024-02221-0","type":"published","date":"2024-04-18T22:04:49+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":46673607,"identity":"a430d933-2ffe-4e1a-a809-69d8e1bbb1c8","added_by":"auto","created_at":"2023-11-17 18:50:52","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":27953,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart describing the cohort of patients with CIED and NBHSB, IE, extraction of the CIED, and recurrent infection.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-3615135/v1/b35547baf78b0942e1347989.png"},{"id":46673077,"identity":"ae3cd82f-1bb3-4884-8714-18eefefe7a83","added_by":"auto","created_at":"2023-11-17 18:42:53","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":40667,"visible":true,"origin":"","legend":"\u003cp\u003eSuggested management strategy for patients with CIED and NBHSB\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-3615135/v1/11e1b11252efdeabf982f05c.png"},{"id":55689507,"identity":"dfc41f84-1684-453f-9212-828356bf6e50","added_by":"auto","created_at":"2024-05-01 22:04:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":711378,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3615135/v1/490bafc2-b4dd-493a-9e8a-d9ff5108da68.pdf"},{"id":46673075,"identity":"53e5b95e-2d56-401a-ac70-4237149a91de","added_by":"auto","created_at":"2023-11-17 18:42:52","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":26635,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarymaterial.docx","url":"https://assets-eu.researchsquare.com/files/rs-3615135/v1/0e0e57ae9f52538fdc2fd1cc.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Non-betahemolytic streptococcal bacteremia, cardiac implantable electronic device, endocarditis, extraction, and outcome; a population- based retrospective cohort study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eInfective endocarditis (IE) is a life-threatening infection, demanding long antibiotic treatment and, under some circumstances, thoracic surgery or other interventions (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). IE can be caused by a plethora of different bacteria (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The most common causative agents are \u003cem\u003eStaphylococcus aureus, Enterococcus faecalis\u003c/em\u003e, and non-beta hemolytic streptococci (NBHS), together constituting the responsible agent for approximately 70% of the IE cases diagnosed (\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). In clinical practice, a positive blood culture (BC) with any of these bacteria, or other prone to cause IE, is often the first observation indicating that a patient has an IE.\u003c/p\u003e \u003cp\u003eCardiac implantable electronic devices (CIEDs) are increasingly used to treat various conditions (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). In the circumstances with bacteremia in a patient with a CIED, an increased risk of IE has been described and a reduced risk of treatment failure has been associated with the extraction of the CIED, why extraction is recommended in cases of CIED IE (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). However, these recommendations are derived from studies of \u003cem\u003eS. aureus\u003c/em\u003e IE or from tertiary referral centers (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). In one study of NBHS bacteremia (NBHSB), CIED was not found to be significantly associated to IE, and thus not included in the HANDOC score, designed to assess the risk of IE in patients with NBHSB (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). In a large study of streptococcal blood stream infections by Chamat-Hedemand \u003cem\u003eet al.\u003c/em\u003e, CIED was found to be a significant risk factor for IE (odds ratio 1.7) (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), but the exact risk of IE in the group of patients with CIED and NBHSB was not addressed. In a recent publication on NBHSB and risk factors for IE, CIED was significantly associated with IE in univariable analysis but in multivariable analysis no correlation was seen, likely due to the covariation with other risk factors (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe risk of IE has been shown to be very different between different NBHS groups and species (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). However, the nomenclature and taxonomy of the NBHS are complicated and misunderstandings are common, why a comparison of the results of different studies has been impaired.\u003c/p\u003e \u003cp\u003eThe aims of this study were to describe a population-based cohort of patients with CIED and NBHSB, the rate of IE and recurrent infection, identify variables associated to IE, and to describe the clinical presentation of the recurrent infections. We also aimed to suggest how this complicated clinical situation can be managed.\u003c/p\u003e"},{"header":"Material and methods","content":"\u003cp\u003eThe cohort\u003c/p\u003e\n\u003cp\u003eInformation on all consecutive BCs positive for NBHSfrom January 2015 to December 2018, were obtained from the laboratory databases of Clinical Microbiology, Region Sk\u0026aring;ne, Lund, Sweden, the only laboratory in the region, with a catchment area population of 1.36 million inhabitants in 2018. All medical records of patients older than 18 years were studied retrospectively and patients with CIED at place at the time of the bacteremia constituted the study cohort. From these patients, detailed information was collected and stored in accordance with the ethical approval obtained from the Swedish Ethics Committee (2020-00314). Data were collected by\u0026nbsp;JL\u0026nbsp;and were validated by MR and AB.\u003c/p\u003e\n\u003cp\u003eDefinitions\u003c/p\u003e\n\u003cp\u003eThe definitions of IE and CIED infection were used according to the European Society of Cardiology (ESC) criteria by Habib \u003cem\u003eet al.\u003c/em\u003e (12). In the last analysis in the result section the European Heart Rhythm Association (EHRA) diagnostic criteria from Blomstr\u0026ouml;m-Lundqvist \u003cem\u003eet al\u003c/em\u003e.(6), ESC 2023 guidelines diagnostic criteria\u0026nbsp;(1), and the Duke-International Society for Cardiovascular Infectious Diseases (ISCVID) criteria\u0026nbsp;(13). The minor criterium predisposition to IE was used according to Dajani \u003cem\u003eet al.\u003c/em\u003e (14), and in the comparison of the different diagnostic criteria systems, with the modifications described in the respective system. All changes seen on TTE or TEE, indicating IE, was considered to be caused by infection due to the difficulty to differentiate from changes due to other causes\u0026nbsp;(15)\u0026nbsp;and the assumed high pretest probability for CIED IE in this cohort. All infections fulfilling the criteria for definite IE were referred to as CIED IE irrespective whether changes were found on the CIED or heart valves\u0026nbsp;(6).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAn episode of NBHSB was defined by the start of the clinical symptoms or signs in a patient resulting in blood culture taken, showing growth of NBHS. An episode was delimited by at least seven days of effective treatment and clinical improvement or, if not fulfilled, after 30 days. A later clinical condition resulting in a BC being taken with growth of NBHS, of the same species as in the first episode, within the study period of 365 days, was referred to as a \u0026ldquo;recurrent infection\u0026rdquo; or \u0026ldquo;recurrence\u0026rdquo; and was not included in the study as a first or primary episode in tables 1-3. The expression \u0026ldquo;recurrent infection\u0026rdquo; or \u0026ldquo;recurrence\u0026rdquo; was used in this study since it cannot be determined whether the infection was caused by the same bacterium, indicating relapse, or by another NBHS clone indicating a reinfection.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe primary endpoint was definite IE. A secondary endpoint was recurrent infection with the same species of NBHS during the observation period.\u003c/p\u003e\n\u003cp\u003eOrigin of infection and other focal infections caused by NBHS were defined as described\u0026nbsp;(16).\u0026nbsp;Comorbidities were retrieved from registrations in the medical records prior to the episode and classified according to the Charlson index modified by Quan \u003cem\u003eet al.\u003c/em\u003e (17, 18). The HANDOC scores were calculated as described\u0026nbsp;(9).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMicrobiology\u003c/p\u003e\n\u003cp\u003eDuring the study period guidelines recommended that two sets of blood culture bottles (aerobic and anaerobic) should be taken from two separate venipunctures. The blood culture system in use was BACTEC FX (BectonDickinson, Franklin Lakes, United States), using a 5-day incubation unless otherwise requested. The main method for species determination was matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS: Bruker Daltonics, using the Bruker MBT Compass library version most recent at the time of sample analysis), with a PCR and 16S sequencing using the Sanger method as a second line method for selected hard-to-identify isolates.\u0026nbsp;Species designations were used according to the 2022 International Code of Nomenclature of Prokaryotes (ICPN) and the List of Prokaryotic names with Standing in Nomenclature (LPSN)\u0026nbsp;(19, 20). The grouping of streptococcal species into the \u003cem\u003eS. mitis\u003c/em\u003e group, \u003cem\u003eS. anginosus\u003c/em\u003e group, \u003cem\u003eS. sanguinis\u0026nbsp;\u003c/em\u003egroup, \u003cem\u003eS. salivarius\u003c/em\u003e group, \u003cem\u003eS. mutans\u003c/em\u003e group, and \u003cem\u003eS. bovis\u003c/em\u003e group was done in concordance with previous publications\u0026nbsp;(9, 21-23).\u003c/p\u003e\n\u003cp\u003eData collection and analysis\u003c/p\u003e\n\u003cp\u003eThe collection of the microbiological and clinical data of an episode was from 365 days before its start until 365 days after the first positive BC during that episode. The collected variables are listed in the Supplementary material. The number of CIED carriers in the Region was taken from the Swedish Pacemaker and Implantable Cardioverter-Defibrillator Registry.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe analysis of the collected data was conducted in Stata, version 15.1 (StataCorp, College Station, TX, USA). To describe the differences in dichotomous variables the\u0026nbsp;\u0026chi;\u003csup\u003e2\u003c/sup\u003e test\u0026nbsp;was used and if the prerequisites were not met, the \u003cem\u003ep-\u003c/em\u003evalue of Fisher\u0026rsquo;s exact test was used. Differences between continuous variables were analyzed with Wilcoxon\u0026rsquo;s rank-sum test as normal distribution was not assumed. Values are presented as proportions or medians with interquartile ranges (IQR).\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe cohort\u003c/p\u003e\n\u003cp\u003eThe data extraction from the laboratory resulted in 1637 episodes of NBHSB in the four-year study period (2015-2018). In 79 patients with 85 episodes, a CIED was found at place at the time for the bacteremia. During the study period, the average number of persons with CIED and population in the region, was 8869 and 1 315 000, respectively, giving an incidence of 0.22 NBHSB/1000 CIED/year. The first episode in each patient was further studied and accounted for in tables 1-3. The six episodes of recurrent infections are described in table 4. Definite IE was diagnosed during eight of the primary episodes and the CIED was extracted during four episodes. No recurrent infections were diagnosed during the observation time after the IE episodes. The 71 episodes not diagnosed with definite IE, were followed by a recurrent episode in four patients, and IE was diagnosed in three of these patients during the recurrences (Figure 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eVariables associated with IE\u003c/p\u003e\n\u003cp\u003eFor the first episodes in the patients of the cohort, clinical variables are presented using univariable analysis to identify variables associated with IE (Table 1). Community acquisition was more common in the IE group. Predisposition and one of its components, HVP, and a BC fulfilling the major criterion for IE were significantly more common among patients diagnosed with IE. Both the HANDOC score as a continuous variable and the positive HANDOC score with the stipulated cut off of \u0026ge;3 points were significantly associated with IE.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn table 2, the distribution of IE and non-IE episodes, between the different groups constituting the NBHS are described. The group of patients with \u003cem\u003eS. mutans\u003c/em\u003e bacteremia had two episodes of IE out of three episodes and none of the 16 episodes of \u003cem\u003eS. anginosus\u003c/em\u003e bacteremia had IE. The distribution was significantly different from the one expected by chance, \u003cem\u003ep\u003c/em\u003e-value 0.047 (Table 2).\u003c/p\u003e\n\u003cp\u003eManagement and outcome\u003c/p\u003e\n\u003cp\u003eThe management and outcome of the patients in the 79 episodes are described (Table 3) using univariable analysis. In 56 episodes (71%) an echocardiography was performed, 39 patients (49%) were examined with TEE. Four patients were evaluated with PET-CT, out of which one was indicative of IE. No cardiac CT was performed. In 62 episodes a total of 83 examinations (51 radiology of the lungs, 13 CT of the lungs, and 19 CT of the abdomen) were performed to identify embolic events. Of these, two indicated embolization.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe CIED was extracted in four patients, all with changes visualized on the CIED, and two fulfilling the criteria for definite IE. No patient had a positive culture from an extracted CIED and in one patient, the 16S analysis confirmed the BC result. The one-year overall mortality in the entire cohort was 30%. The comparison between patients diagnosed with definite IE and without the diagnosis demonstrated significant differences in the rate of echocardiography performed, the rate of extraction, and the treatment time (Table 3). No significant differences were seen in recurrences or mortality.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe recurrent infections\u003c/p\u003e\n\u003cp\u003eIn the four episodes followed by a recurrent NBHSB, three of the patients had a HVP and in the same three TEE, but not PET-CT, was performed during the first episode (Table 4). No focal infection was diagnosed in any of the four patients and the patients were treated with antibiotics for 2, 10, 15, and 15 days, respectively. The patients had positive BC with the same group of NHBS in both episodes. Two of the patients with recurrence had bacteremia with the \u003cem\u003eS. bovis\u0026nbsp;\u003c/em\u003egroup, one with \u003cem\u003eS. salivarius\u003c/em\u003e, and one with the \u003cem\u003eS. mitis\u0026nbsp;\u003c/em\u003egroup.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe three patients with the HVP were all diagnosed to have an IE during the recurrency. Two of the patients had the major structural criterion by a positive TEE and one had a PET-CT showing IE. None of the recurrent infections had visible changes on the CIED. Two of the were subjected to surgery and one died during the treatment but 54 days after the second episode (Table 4).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAlternative diagnostic criteria systems\u003c/p\u003e\n\u003cp\u003eIn this study, the diagnostic criteria of ESC 2015 was used (12). A comparison with three other diagnostic criteria systems is described in Table 5. The ESC 2015 and EHRA 2020 result in the same distribution of definite, possible, and rejected IE. The results of the ESC 2023 and the Duke-ISCVID diagnostic criteria systems result in the same distribution of classification of IE but differs from the former, as one additional episode was classified as definite IE and four episodes were reclassified from rejected IE to possible IE (Table 5).\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe main finding in this study is that IE is found in 10% of a population-based cohort of patients with CIED and NBHSB and extraction of the CIED was not performed unconditionally in cases of CIED IE. Further, a low rate of recurrent infections (5%) was encountered. Finally, three patients were diagnosed with IE during the recurrent infections, all related to an HVP.\u003c/p\u003e \u003cp\u003eThe role of CIED in the pathogenesis of IE is debated. Whether CIED is a risk factor for IE, most likely depends on the species of the causing bacterium. In studies of patients with \u003cem\u003eS. aureus\u003c/em\u003e bacteremia it was demonstrated that CIED was a risk factor for IE (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) while in \u003cem\u003eEnterococcus faecalis\u003c/em\u003e bacteremia, the presence of a CIED was not shown to be associated with IE (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). In a previous study of NBHSB (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), CIED was not significantly associated with IE (but with a \u003cem\u003ep\u003c/em\u003e-value close to 0.05). In that study CIED covaried with HVP, which was shown to predict IE (unpublished data). In another NBHSB and IE study, CIED was associated to IE in univariable analysis but in multivariable analysis, an odds ratio of 0.66 was found (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Chamat-Hedemand \u003cem\u003eet al.\u003c/em\u003e described a large cohort of patients with patients with CIED and NBHSB but in the calculation resulting in CIED being a significant risk factor for IE, the patients with bacteremia with species addressed in this study only constitute a minority (approximately 30%).\u003c/p\u003e \u003cp\u003eIn two alternative IE diagnostic criteria systems (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), CIED is included among the different conditions constituting the predisposition minor criterium, resulting in that all patients in this cohort have that minor criterion. This change in the diagnostic criteria did not result in any profound differences in the rates of definite and possible IE. The data presented in this study neither indicate CIED to be a strong risk factor for IE in NBHSB nor contributes to result in a better performance for the diagnostic criteria if introduced as a minor criterion.\u003c/p\u003e \u003cp\u003eThe results of this study were in line with the findings in several studies (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), showing that the risk of IE was diverse between groups of NBHS. \u003cem\u003eS. sanguinis, S. bovis\u003c/em\u003e, and \u003cem\u003eS. mutans\u003c/em\u003e are prone to cause IE, \u003cem\u003eS. mitis\u003c/em\u003e and \u003cem\u003eS. salivarius\u003c/em\u003e are connected to an intermediate risk, and \u003cem\u003eS anginosus\u003c/em\u003e is unlikely to cause IE.\u003c/p\u003e \u003cp\u003eIn only four patients (5%) in the entire cohort, the CIED was extracted and in patients fulfilling the criteria for definite IE, two out of 8 (25%) of the patients had the CIED extracted. None of the patients with IE had a recurrent infection that would indicate treatment failure. The guidelines recommend extraction of the CIED in cases diagnosed with CIED infection or CIED IE (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) but this was not performed in our cohort, challenging the necessity to follow the recommendations.\u003c/p\u003e \u003cp\u003eFour out of 71 patients (6%) not diagnosed with IE had a recurrent infection with NBHSB, and none was found to have CIED changes. However, three patients had suspected missed left sided HVP IE. Although beyond the scope of this study, the three missed HVP IE with recurrent infections illustrate the importance of continuing the evaluation of a patient with HVP, NBHSB, and a negative TEE. Such patients could be subjected to PET-CT, cardiac CT, repeated TEE, or followed clinically for early detection of relapse (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBased on our results, we suggest a management strategy that includes that all patients should be evaluated with TEE and, if negative, a PET-CT or possibly cardiac CT could be considered if the suspicion of CIED IE remains. The size of our study does not permit us to identify specific risk factors for IE in patients with CIED and thus the HANDOC score is suggested to be used to direct the management after a negative TEE. None of the diagnosed episodes of definite IE, nor any of the patients with a recurrent infection, had a negative HANDOC-score. Thus, we propose that the risk of IE would be negligible with both a negative TEE and a negative HANDOC score and further evaluation for IE could be omitted (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Another line of inquiry would be to test the hypothesis that TEE can be omitted in patients with CIED, NBHSB, and a negative HANDOC score. However, this suggestion has to be tested in future prospective studies.\u003c/p\u003e \u003cp\u003eAlthough this is the largest study cohort focusing on CIED-carrying patients with NBHSB, it has obvious limitations. The retrospective design and the far from complete evaluation using TEE (49%), make it possible that some patients with changes on the CIED could have been missed. Moreover, only four patients were subjected to PET-CT, also possibly contributing to under-diagnosis. Furthermore, despite the long follow up and thorough evaluation of the medical records, some patients could have died of an undiagnosed IE, another undiagnosed NBHS infection, or a recurrent infection. Finally, we do not know if the recurrent infections were true relapses or reinfection with another clone from the same group NBHS.\u003c/p\u003e \u003cp\u003eDespite the shortcomings, we believe that the observation of low frequency of CIED infections in NBHSB and the suggestion of a management algorithm has implications for the management of the patients.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThe work was supported by the Swedish Government Fund for Clinical Research (ALF) and the foundations of \u0026Ouml;sterlund and Sk\u0026aring;ne University Hospital to MR.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors have seen and approved the manuscript, contributed significantly to the work, and the manuscript has not been previously published nor is not being considered for publication elsewhere.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDelgado V, Ajmone Marsan N, de Waha S, Bonaros N, Brida M, Burri H, et al. 2023 ESC Guidelines for the management of endocarditis: Developed by the task force on the management of endocarditis of the European Society of Cardiology (ESC) Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS) and the European Association of Nuclear Medicine (EANM). European Heart Journal. 2023.\u003c/li\u003e\n\u003cli\u003eBaddour LM, Shafiyi A, Lahr BD, Anavekar NS, Steckelberg JM, Wilson WR, et al. A Contemporary Population-Based Profile of Infective Endocarditis Using the Expanded Rochester Epidemiology Project. Mayo Clin Proc. 2021;96(6):1438-45.\u003c/li\u003e\n\u003cli\u003ePant S, Patel NJ, Deshmukh A, Golwala H, Patel N, Badheka A, et al. Trends in infective endocarditis incidence, microbiology, and valve replacement in the United States from 2000 to 2011. J Am Coll Cardiol. 2015;65(19):2070-6.\u003c/li\u003e\n\u003cli\u003eNoubiap JJ, Nkeck JR, Kwondom BS, Nyaga UF. Epidemiology of infective endocarditis in Africa: a systematic review and meta-analysis. Lancet Glob Health. 2022;10(1):e77-e86.\u003c/li\u003e\n\u003cli\u003ePriori SG, Blomstr\u0026ouml;m-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, et al. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Eur Heart J. 2015;36(41):2793-867.\u003c/li\u003e\n\u003cli\u003eBlomstr\u0026ouml;m-Lundqvist C, Traykov V, Erba PA, Burri H, Nielsen JC, Bongiorni MG, et al. European Heart Rhythm Association (EHRA) international consensus document on how to prevent, diagnose, and treat cardiac implantable electronic device infections-endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), the Latin American Heart Rhythm Society (LAHRS), International Society for Cardiovascular Infectious Diseases (ISCVID) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Europace. 2020;22(4):515-49.\u003c/li\u003e\n\u003cli\u003ePalraj BR, Baddour LM, Hess EP, Steckelberg JM, Wilson WR, Lahr BD, Sohail MR. 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.\u003c/li\u003e\n\u003cli\u003eSohail MR, Palraj BR, Khalid S, Uslan DZ, Al-Saffar F, Friedman PA, et al. Predicting risk of endovascular device infection in patients with Staphylococcus aureus bacteremia (PREDICT-SAB). Circ Arrhythm Electrophysiol. 2015;8(1):137-44.\u003c/li\u003e\n\u003cli\u003eSunnerhagen T, T\u0026ouml;rnell A, Vikbrant M, Nilson B, Rasmussen M. HANDOC: A Handy Score to Determine the Need for Echocardiography in Non-\u0026beta;-Hemolytic Streptococcal Bacteremia. Clinical Infectious Diseases. 2018;66(5):693-8.\u003c/li\u003e\n\u003cli\u003eChamat-Hedemand S, Dahl A, \u0026Oslash;stergaard L, Arpi M, Fosb\u0026oslash;l E, Boel J, et al. Prevalence of Infective Endocarditis in Streptococcal Bloodstream Infections Is Dependent on Streptococcal Species. Circulation. 2020;142(8):720-30.\u003c/li\u003e\n\u003cli\u003eSeo H, Hyun J, Kim H, Park S, Chung H, Bae S, et al. Risk and Outcome of Infective Endocarditis in Streptococcal Bloodstream Infections according to Streptococcal Species. Microbiol Spectr. 2023;11(4):e0104923.\u003c/li\u003e\n\u003cli\u003eHabib 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(44):3075-128.\u003c/li\u003e\n\u003cli\u003eFowler VG, Durack DT, Selton-Suty C, Athan E, Bayer AS, Chamis AL, et al. The 2023 Duke-ISCVID Criteria for Infective Endocarditis: Updating the Modified Duke Criteria. Clin Infect Dis. 2023.\u003c/li\u003e\n\u003cli\u003eDajani AS, Bisno AL, Chung KJ, Durack DT, Freed M, Gerber MA, et al. Prevention of bacterial endocarditis. Recommendations by the American Heart Association. JAMA. 1990;264(22):2919-22.\u003c/li\u003e\n\u003cli\u003eGeorge MP, Esquer Garrigos Z, Vijayvargiya P, Anavekar NS, Luis SA, Wilson WR, et al. Discriminative Ability and Reliability of Transesophageal Echocardiography in Characterizing Cases of Cardiac Device-Lead Vegetations versus Non-Infectious Echodensities. Clin Infect Dis. 2020.\u003c/li\u003e\n\u003cli\u003eBerge A, Krantz A, Ostlund H, Naucler 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.\u003c/li\u003e\n\u003cli\u003eCharlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-83.\u003c/li\u003e\n\u003cli\u003eQuan H, Li B, Couris CM, Fushimi K, Graham P, Hider P, et al. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol. 2011;173(6):676-82.\u003c/li\u003e\n\u003cli\u003eParte AC, Sarda Carbasse J, Meier-Kolthoff JP, Reimer LC, Goker M. List of Prokaryotic names with Standing in Nomenclature (LPSN) moves to the DSMZ. Int J Syst Evol Microbiol. 2020;70(11):5607-12.\u003c/li\u003e\n\u003cli\u003eOren A, Arahal DR, Goker M, Moore ERB, Rossello-Mora R, Sutcliffe IC. International Code of Nomenclature of Prokaryotes. Prokaryotic Code (2022 Revision). Int J Syst Evol Microbiol. 2023;73(5a).\u003c/li\u003e\n\u003cli\u003eSunnerhagen T, H\u0026oslash;jgaard Andersen M, Bruun NE, Bundgaard H, Iversen KK, Rasmussen M. External validation of the HANDOC score \u0026ndash; high sensitivity to identify patients with non-beta-haemolytic streptococcal endocarditis. Infectious Diseases. 2020;52(1):54-7.\u003c/li\u003e\n\u003cli\u003ePoyart C, Quesne G, Trieu-Cuot P. Taxonomic dissection of the Streptococcus bovis group by analysis of manganese-dependent superoxide dismutase gene (sodA) sequences: reclassification of \u0026apos;Streptococcus infantarius subsp. coli\u0026apos; as Streptococcus lutetiensis sp. nov. and of Streptococcus bovis biotype 11.2 as Streptococcus pasteurianus sp. nov. Int J Syst Evol Microbiol. 2002;52(Pt 4):1247-55.\u003c/li\u003e\n\u003cli\u003eRichards VP, Palmer SR, Pavinski Bitar PD, Qin X, Weinstock GM, Highlander SK, et al. Phylogenomics and the dynamic genome evolution of the genus Streptococcus. Genome Biol Evol. 2014;6(4):741-53.\u003c/li\u003e\n\u003cli\u003eTubiana S, Duval X, Alla F, Selton-Suty C, Tattevin P, Delahaye 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):544-53.\u003c/li\u003e\n\u003cli\u003ePlainvert C, Matuschek E, Dmytruk N, Gaillard M, Frigo A, Ballaa Y, et al. Microbiological Epidemiology of Invasive Infections Due to Non-Beta-Hemolytic Streptococci, France, 2021. Microbiol Spectr. 2023;11(3):e0016023.\u003c/li\u003e\n\u003cli\u003eFriedman ND, Kaye KS, Stout JE, McGarry SA, Trivette SL, Briggs JP, et al. Health care--associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections. Ann Intern Med. 2002;137(10):791-7.\u003c/li\u003e\n\u003cli\u003eLi JS, Sexton DJ, Mick N, Nettles R, Fowler VG, Jr., Ryan T, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis. 2000;30(4):633-8.\u003c/li\u003e\n\u003cli\u003eBizzini A, Durussel C, Bille J, Greub G, Prod\u0026apos;hom G. Performance of matrix-assisted laser desorption ionization-time of flight mass spectrometry for identification of bacterial strains routinely isolated in a clinical microbiology laboratory. J Clin Microbiol. 2010;48(5):1549-54.\u003c/li\u003e\n\u003cli\u003eSonesson A, \u0026Ouml;qvist B, Hagstam P, Bj\u0026ouml;rkman-Burtscher IM, Mi\u0026ouml;rner H, Petersson AC. An immunosuppressed patient with systemic vasculitis suffering from cerebral abscesses due to Nocardia farcinica identified by 16S rRNA gene universal PCR. Nephrol Dial Transplant. 2004;19(11):2896-900.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1. Background and presentation of the patients with CIED and NBHSB.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"93%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.2680412371134%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAll\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=79) (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEpisodes with definite IE (n=8) (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEpisodes without definite IE\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=71) (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.2680412371134%\" valign=\"top\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e84 (76-88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e84 (70-87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e84 (76-88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.2680412371134%\" valign=\"top\"\u003e\n \u003cp\u003eSex (female)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e18 (23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e2 (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e16 (23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.2680412371134%\" valign=\"top\"\u003e\n \u003cp\u003eCharlson score\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e2 (1-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e2 (1-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e2 (1-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.2680412371134%\" valign=\"top\"\u003e\n \u003cp\u003eAcquisition:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.046\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.2680412371134%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Community\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e40 (51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e7 (88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e33 (46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.2680412371134%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Health care associated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e27 (34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e1 (12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e26 (37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.2680412371134%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Nosocomial\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e12 (17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e12 (15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.2680412371134%\" valign=\"top\"\u003e\n \u003cp\u003eCIED implantation (years)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e5 (3-8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e6 (4-8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e5 (2-8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.2680412371134%\" valign=\"top\"\u003e\n \u003cp\u003eType of CIED:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.2680412371134%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;PPM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e69 (87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e7 (88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e62 (87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.2680412371134%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;ICD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e10 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e1 (12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e9 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.2680412371134%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; Predisposition, any\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e24 (31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e6 (75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e18 (26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.01\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.2680412371134%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Cardiac predisposition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e24 (19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e6 (75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e18 (26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.01\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.2680412371134%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Native valve disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e9 (11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e1 (12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e8 (11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.2680412371134%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Prosthetic heart valve\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e15 (14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e5 (62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e10 (14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.005\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.2680412371134%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Previous endocarditis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e2 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e2 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.2680412371134%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; Intravenous drug user\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.2680412371134%\" valign=\"top\"\u003e\n \u003cp\u003eHeart murmur or valve disease\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e27 (34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e6 (75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e21 (27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.2680412371134%\" valign=\"top\"\u003e\n \u003cp\u003eFever ≥38 degrees\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e62 (78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e5 (62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e57 (80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.2680412371134%\" valign=\"top\"\u003e\n \u003cp\u003eEmbolization\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e1 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e1 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.2680412371134%\" valign=\"top\"\u003e\n \u003cp\u003eBC major criterion for IE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e42 (53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e8 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e34 (48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.006\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.2680412371134%\" valign=\"top\"\u003e\n \u003cp\u003eTime to positive BC (hours)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e18 (11-29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e17 (13-22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e18 (11-30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.2680412371134%\" valign=\"top\"\u003e\n \u003cp\u003eSOFA score (≥2 points)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e32 (41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e4 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e28 (39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.2680412371134%\" valign=\"top\"\u003e\n \u003cp\u003eKnown origin of infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e22 (28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e1 (12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e21 (30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.2680412371134%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Pocket infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e1 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e1 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.2680412371134%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Other origin of infections\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e21 (27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e21 (30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.2680412371134%\" valign=\"top\"\u003e\n \u003cp\u003eUnknown origin of infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e57 (72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e7 (88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e50 (70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.2680412371134%\" valign=\"top\"\u003e\n \u003cp\u003eDuration of symptoms (days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e3 (1-6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e4 (2-22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e2 (1-6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.2680412371134%\" valign=\"top\"\u003e\n \u003cp\u003eHANDOC score (points)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e2 (1-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e5 (4-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e1 (2-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.2680412371134%\" valign=\"top\"\u003e\n \u003cp\u003ePositive HANDOC score (≥3 points)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e34 (43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e8 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\" valign=\"top\"\u003e\n \u003cp\u003e26 (37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eFootnote:\u0026nbsp;Univariable analysis of differences between patients diagnosed with definite IE and patients without definite IE.\u0026nbsp;Values are given as numbers and proportions (%) and for continuous variables as medians and IQR. The \u003cem\u003ep\u003c/em\u003e-value of differences in continuous variable were calculated with Wilcoxon’s rank sum test. In categorical variables, the differences were calculated using the χ\u003csup\u003e2\u003c/sup\u003e test when applicable and Fisher’s exact test in other cases. Differences with a \u003cem\u003ep\u003c/em\u003e–value of \u0026lt;0.05 are considered significant and are shown in bold. \u003csup\u003e1\u003c/sup\u003eMost common focal infections were: abdominal focus: 10 patients, pneumonia: 3 patients, urinary tract infection: 2 patients, and oral infection: 2 patients.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2. BC results from the cohort of patients with CIED and NBHSB.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.98969072164948%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBC results\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAll\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=79) (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEpisodes with definite IE (n=8) (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEpisodes without definite IE (n=71) (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.98969072164948%\" valign=\"top\"\u003e\n \u003cp\u003eAll NBHS BC results:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.047\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.98969072164948%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;\u003cem\u003eS. mitis\u003c/em\u003e group\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e29 (37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e3 (38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e26 (37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.98969072164948%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;\u003cem\u003eS. sanguinis\u0026nbsp;\u003c/em\u003egroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e2 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e2 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.98969072164948%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;\u003cem\u003eS. bovis\u003c/em\u003e group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e17 (22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e2 (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e15 (21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.98969072164948%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;\u003cem\u003eS. anginosus\u003c/em\u003e group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e16 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e16 (23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003e0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.98969072164948%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;\u003cem\u003eS. mutans\u003c/em\u003e group\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e3 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e2 (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e1 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.03\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.98969072164948%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;\u003cem\u003eS. salivarius\u003c/em\u003e group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e11 (14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e1 (12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e10 (14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.98969072164948%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Other NBHS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e1 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e1 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eFootnote:\u0026nbsp;Univariable logistic regression of differences between patients diagnosed with definite IE and patients without definite IE.\u0026nbsp;Values are given as numbers and proportions (%). The \u003cem\u003ep\u003c/em\u003e-value of differences were calculated using the χ\u003csup\u003e2\u003c/sup\u003e test when applicable and Fisher’s exact test in other cases. Differences with a \u003cem\u003ep\u003c/em\u003e–value of \u0026lt;0.05 are considered significant and are shown in bold.\u003c/p\u003e\n\u003cp\u003eTable 3. Management and outcome of the patients with CIED and NBHSB.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"98%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.673469387755105%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; Characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAll\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=79) (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEpisodes with definite IE (n=8) (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEpisodes without definite IE (n=71) (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.673469387755105%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eManagement\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.673469387755105%\" valign=\"top\"\u003e\n \u003cp\u003eTTE performed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e54 (68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e8 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e46 (65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.051\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.673469387755105%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Positive for IE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e4 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e3 (38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e1 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.673469387755105%\" valign=\"top\"\u003e\n \u003cp\u003eTOE performed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e39 (49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e7 (88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e32 (45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.029\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.673469387755105%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Positive for IE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e8 (10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e6 (75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e2 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.673469387755105%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; CIED changes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e5 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e3 (38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e2 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.006\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.673469387755105%\" valign=\"top\"\u003e\n \u003cp\u003ePET-CT performed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e4 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e1 (12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e3 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.673469387755105%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Positive for IE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e1 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e1 (12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.673469387755105%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; CIED changes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.673469387755105%\" valign=\"top\"\u003e\n \u003cp\u003eExtraction of CIED\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e4 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e2 (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e2 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.049\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.673469387755105%\" valign=\"top\"\u003e\n \u003cp\u003eTreatment, total, (days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e13 (10-21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e28 (22-29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e13 (10-18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.673469387755105%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eOutcome\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.673469387755105%\" valign=\"top\"\u003e\n \u003cp\u003eRecurrence in NBHSB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e4 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e4 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.673469387755105%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Diagnosed with IE\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e3 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e3 (75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.673469387755105%\" valign=\"top\"\u003e\n \u003cp\u003eDeath within 30 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e14 (18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e1 (12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e13 (18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.673469387755105%\" valign=\"top\"\u003e\n \u003cp\u003eDeath within 365 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e24 (30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e3 (38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e21 (30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eFootnote: Univariable analysis of differences between patients diagnosed with definite IE and patients without definite IE.\u0026nbsp;Values are given as numbers and proportions (%) and for continuous variables as medians and IQR. The \u003cem\u003ep\u003c/em\u003e-value of differences in continuous variable were calculated with Wilcoxon’s rank sum test. In categorical variables, the differences were calculated using the χ\u003csup\u003e2\u003c/sup\u003e test when applicable and Fisher’s exact test in other cases. Differences with a \u003cem\u003ep\u003c/em\u003e–value of \u0026lt;0.05 are considered significant and are shown in bold.\u003c/p\u003e\n\u003cp\u003eTable 4. The clinical presentation of the patient with the recurrent episodes of NBHSB\u003c/p\u003e\n\u003cp\u003e\u003cimg src=\"data:image/png;base64,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\" width=\"742\" height=\"300\"\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eFootnote:\u0026nbsp;U: unknown focus, IE: endocarditis, +: positive finding. \u003csup\u003e1\u003c/sup\u003eEnd of antibiotic therapy. \u003csup\u003e2\u003c/sup\u003eThree recurrent episodes, extraction of CIED and heart surgery during the third after positive PET-CT; last episode without known focus. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 5. The outcome of four different diagnostic criteria systems\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003ePatients, n=79\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003eESC 2015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003eEHRA 2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003eESC 2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003eDuke-ISCVID 2023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003eDefinite IE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003ePossible IE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003eRejected IE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eFootnote: The diagnostic criteria systems have been abbreviated: ESC 2015 (12), EHRA 2020 (6), Duke-ISCVID 2023 (13), and the ESC 2023 (1). The ESC 2015 diagnostic criteria were used in this study.\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"infection","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infe","sideBox":"Learn more about [Infection](http://link.springer.com/journal/15010)","snPcode":"15010","submissionUrl":"https://submission.nature.com/new-submission/15010/3","title":"Infection","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Non-beta-hemolytic Streptococcus, bacteremia, endocarditis, CIED, extraction, and recurrent infection","lastPublishedDoi":"10.21203/rs.3.rs-3615135/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3615135/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003ePatients with non-beta-hemolytic streptococcal bacteremia (NBHSB) are at risk of infective endocarditis (IE). Patients with cardiac implantable electronic device (CIED) have been described to have an increased risk of IE. The aim of the study was to describe a population-based cohort of patients with NBHSB and CIED and variables associated with IE and recurrent NBHSB.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eAll episodes with NBHSB in blood culture from 2015 to 2018 in a population of 1.3\u0026nbsp;million inhabitants were collected from the Clinical Microbiology Laboratory, Lund, Sweden. Through medical records, patients with CIED during NBHSB were identified and clinical data were collected. Patients were followed 365 days after NBHSB.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eEighty-five episodes in 79 patients with CIED and NBHSB constituted the cohort. Eight patients (10%) were diagnosed with definite IE during the first episode, five of whom also had heart valve prosthesis (HVP). In 39 patients (49%) transesophageal echocardiography (TEE) was performed of which six indicated IE. Four patients had the CIED extracted. Twenty-four patients did not survive (30%) the study period. Four patients had a recurrent infection with NBHSB with the same species, three of whom had HVP and had been evaluated with TEE with a negative result during the first episode and diagnosed with IE during the recurrency.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe study did not find a high risk of IE in patients with NBHSB and CIED. Most cases of IE were in conjunction with a simultaneous HVP. A management algorithm is suggested.\u003c/p\u003e","manuscriptTitle":"Non-betahemolytic streptococcal bacteremia, cardiac implantable electronic device, endocarditis, extraction, and outcome; a population- based retrospective cohort study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-11-17 18:42:48","doi":"10.21203/rs.3.rs-3615135/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-01-22T16:17:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-01-13T12:58:10+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-12-03T11:22:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"938a33a4-110f-439d-b326-a59a253e7e17","date":"2023-11-23T10:18:06+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-11-20T16:35:16+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-11-15T18:14:30+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-11-15T12:38:32+00:00","index":"","fulltext":""},{"type":"submitted","content":"Infection","date":"2023-11-15T12:27:50+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"infection","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infe","sideBox":"Learn more about [Infection](http://link.springer.com/journal/15010)","snPcode":"15010","submissionUrl":"https://submission.nature.com/new-submission/15010/3","title":"Infection","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"796463c5-1b82-45af-89e2-3819e10ef681","owner":[],"postedDate":"November 17th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-05-01T22:04:49+00:00","versionOfRecord":{"articleIdentity":"rs-3615135","link":"https://doi.org/10.1007/s15010-024-02221-0","journal":{"identity":"infection","isVorOnly":false,"title":"Infection"},"publishedOn":"2024-04-18 22:04:49","publishedOnDateReadable":"April 18th, 2024"},"versionCreatedAt":"2023-11-17 18:42:48","video":"","vorDoi":"10.1007/s15010-024-02221-0","vorDoiUrl":"https://doi.org/10.1007/s15010-024-02221-0","workflowStages":[]},"version":"v1","identity":"rs-3615135","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3615135","identity":"rs-3615135","version":["v1"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}