# Pneumococcal infective endocarditis in Brazil: a multicenter study on a severe condition

## TL;DR

This study examines pneumococcal infective endocarditis in Brazil, highlighting its severity and high mortality rate despite antibiotic treatment.

## Contribution

The study provides new insights into the clinical characteristics and outcomes of pneumococcal infective endocarditis in Brazil.

## Key findings

- Pneumococcal infective endocarditis was identified in 0.47% of IE cases, with a high mortality rate of 6/11.
- Surgical intervention was indicated for all patients, but only 6 underwent surgery, with better outcomes in those who did.
- The study emphasizes the importance of prompt diagnosis and vaccination for at-risk patients.

## Abstract

Streptococcus pneumoniae bacteremia may result in Infective Endocarditis (IE). In the pre-antibiotic era, it caused 10 %‒15 % of IE, decreasing to < 3 % after penicillin availability. Although infrequent, it causes aggressive disease.

Retrospective analysis of endocarditis databases, prospectively implemented in 4 Brazilian institutions, 2005‒2023.

From the prospective cohorts comprising 2321 adult patients with IE, we identified 11 (0.47%) with pneumococcal IE. Males represented 7/11 and mean age was 54 years (22‒77). All had native valve involvement; perivalvular abscess was present in 6/11. Only one patient had concurrent meningitis. Beta-lactams were the antibiotics used in 10/11. All had surgical indication, but only 6 had it, as the others were seriously ill. Overall, in hospital mortality was 6/11, but only 1/6 of those who underwent surgery died, compared to 5/5 of those who had an indication for surgery and did not have it.

The high mortality rates and need for surgical intervention emphasize the need to promptly identify and manage pneumococcal endocarditis. Physicians ought to recommend vaccination to all patients at risk for severe pneumococcal disease.