Clinical characteristics, management and outcomes of enterococcal infective endocarditis: an ancillary study from the ESC-EORP EURO-ENDO registry

European Heart Journal - Quality of Care and Clinical Outcomes

27 November 2025
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ESC Journals CARDIOVASCULAR DISEASE IN SPECIFIC POPULATIONS IMAGING Echocardiography Nuclear Imaging VALVULAR, MYOCARDIAL, PERICARDIAL, PULMONARY, CONGENITAL HEART DISEASE Infective Endocarditis Valvular Heart Disease

Abstract

AbstractAims

Enterococcal infective endocarditis (EIE) represents a growing proportion of infective endocarditis (IE) cases, particularly among elderly and comorbid patients. EIE poses diagnostic and therapeutic challenges, notably regarding optimal antimicrobial therapy and surgical decision-making. We aimed to compare the clinical characteristics, management, and outcomes of EIE vs. non-enterococcal IE (NEIE) in the ESC-EORP EURO-ENDO registry.

Methods and results

This ancillary analysis of the prospective EURO-ENDO registry included adult patients with definite or possible IE enrolled between January 2016 and March 2018. Patients with monomicrobial EIE were compared with those with NEIE. Clinical, microbiological, imaging, and therapeutic data were analysed. Multivariable logistic regression including EuroSCORE II and valve status identified independent predictors of in-hospital mortality. Among 3083 patients, 365 (12%) had monomicrobial EIE. Compared with NEIE, EIE patients were older (mean 68 vs. 58 years), had more comorbidities, and more frequent prosthetic valve involvement (41% vs. 26%). Aortic valve localization and colonic uptake on PET/CT were also more common. In-hospital mortality was similar (16% vs. 17%). After adjustment for EuroSCORE II and valve status, EIE was not independently associated with higher in-hospital mortality (adjusted OR 0.67 [95% confidence interval 0.42–1.04]; P = 0.083). Among 195 EIE patients with 1-year follow-up, recurrence occurred in 6%. Healthcare-associated acquisition, prosthetic valve infection, and recurrence were associated with worse outcomes and lower surgical rates.

Conclusion

EIE affects older, high-risk patients. After adjustment for operative risk, mortality was comparable to other aetiologies, highlighting the need for tailored diagnostic and therapeutic strategies.

Contributors

P Tornos
P Tornos

Author

Mary Philip
Mary Philip

Author

Hospital La Timone of Marseille Marseille , France

C Llibre
C Llibre

Author

L Mateu
L Mateu

Author

R Nunez
R Nunez

Author

Bernard Iung
Bernard Iung

Author

Bichat APHP Site of Paris Nord University Hospital Paris , France

A Bel
A Bel

Author

M Blanes
M Blanes

Author

A Osa
A Osa

Author

M Alvaro
M Alvaro

Author

Bogdan A Popescu
Bogdan A Popescu

Author

Institute of Cardiovascular Diseases Prof. C.C. Iliescu Bucharest , Romania

A Alonso
A Alonso

Author

J Bax
J Bax

Author

J Miro
J Miro

Author

S Gielen
S Gielen

Author

M Almela
M Almela

Author

C Falces
C Falces

Author

D Fuster
D Fuster

Author

F Pinto
F Pinto

Author

J Llopis
J Llopis

Author

F Marco
F Marco

Author

A Moreno
A Moreno

Author

A Tellez
A Tellez

Author

P Vardas
P Vardas

Author

B Vidal
B Vidal

Author

U Zeymer
U Zeymer

Author

M Mahia
M Mahia

Author

A Budaj
A Budaj

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N Dagres

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S Ressi

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L Abid

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J Dho

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B Iung

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S James

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V Novas

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C Shigel

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G Reyes

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S Ouali

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