Characteristics and prognosis of pneumococcal endocarditis: a case-control study.

Case series have suggested that pneumococcal endocarditis is a rare disease, mostly reported in patients with comorbidities but no underlying valve disease, with a rapid progression to heart failure, and high mortality. We performed a case-control study of 28 patients with pneumococal endocarditis (cases), and 56 patients with non-pneumococcal endocarditis (controls), not matched on sex and age, during years 1991-2013, in one referral center. Alcoholism (39.3% vs. 10.7%; P<.01), smoking (60.7% vs. 21.4%%; P<.01), the absence of previously known valve disease (82.1% vs. 60.7%; P=0.047), heart failure (64.3% vs. 23.2%; P<.01), and shock (53.6% vs. 23.2%; P<.01) were more common in pneumococcal than in non-pneumococcal endocarditis. Cardiac surgery was required in 64.3% of patients with pneumococcal endocarditis, much earlier than in patients with non-pneumococcal endocarditis (mean time from symptoms onset, 14.1 ± 18.2 vs. 69.0 ± 61.1 days). In-hospital mortality rates were similar (7.1% vs. 12.5%). Streptococcus pneumoniae causes rapidly progressive endocarditis requiring life-saving early cardiac surgery in most cases