Risk of infective endocarditis in oncohaematological patients undergoing active treatment with Enterococcus faecalis bloodstream infection: A retrospective multicentre study

Abstract

Objectives: Enterococcus faecalis bloodstream infections (EF-BSIs) are a common cause of infective endocarditis (IE). Recent guidelines consider E. faecalis bacteraemia a major criterion for IE and recommend systematic echocardiographic screening. The objective of this study was to describe the risk of IE in patients with an EF-BSI and an active oncohaematological malignancy. Methods: We conducted a retrospective multicentre cohort study across three cancer centres in Barcelona, Spain, including all consecutive adults with EF-BSI and active oncohaematological malignancy who had received oncologic treatment within the previous 3 months from January 2014 to December 2023. Patients were identified via microbiology databases. The primary outcome was a diagnosis of definite IE based on European Society of Cardiology criteria. Secondary outcomes included 30-d mortality, 6-month relapse, and cumulative mortality. Results: A total of 148 patients were included (median age 64.5 y [IQR 57-72]; 53% male). Eighty (54%) patients had a haematological malignancy, and 68 (46%) a solid tumour. Prosthetic heart valves were present in 4 (3%) patients. Most common BSI sources were primary (39, 26%), urinary tract (36, 24%), abdominal or biliary tract (36, 24%), and central venous catheter-related infections (33, 22%). Echocardiography was performed in 22 patients (15%), with only 2 (1%) diagnosed with definite IE: one had a prosthetic valve, and both had persistent bacteraemia. The 30-d mortality rate was 29% and the 6-month cumulative mortality was 55%. Six patients (7%) experienced relapse, with no new IE diagnoses. Conclusions: Systematic IE screening may not be warranted in this population and should instead be individualised on the basis of clinical risk factors. (c) 2025 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)