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Eur J Clin Microbiol Infect Dis. 2018 Dec;37(12):2261-2272. doi: 10.1007/s10096-018-3367-7. Epub 2018 Sep 8.

Infective endocarditis due to Streptococcus dysgalactiae: clinical presentation and microbiological features.

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Department of Clinical Sciences, Division of Infection Medicine, Lund University, BMC B14 Baravägen 27, 223 63, Lund, Sweden.
Clinical Microbiology, Labmedicin, Region Skåne, Lund, Sweden.
Department of Laboratory Medicine Lund, Section of Medical Microbiology, Lund University, Lund, Sweden.
Department of Clinical Microbiology, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
Department of Infectious Diseases, Sahlgrenska University Hospital, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden.
Swedish Society of Infectious Diseases, Swedish Registry of Infective Endocarditis, Gothenburg, Sweden.
Department of Clinical Sciences, Division of Infection Medicine, Lund University, BMC B14 Baravägen 27, 223 63, Lund, Sweden.


Knowledge of infective endocarditis (IE) caused by Streptococcus dysgalactiae (SD) is limited. This study aimed to identify the clinical and microbiological features of SD-caused IE and to investigate any possible synergy between penicillin and gentamicin on SD isolates. Cases of IE 2008-2016 due to SD reported to the Swedish Registry of Infective Endocarditis (SRIE) were identified. Isolates were emm typed and synergy between antibiotics was determined in time-kill experiments. Medical records were reviewed and SD-cases were compared to cases of IE due to other pathogens reported to the SRIE. Fifty cases of SD-caused IE were confirmed. emm types stC74a, stG62647, and stG643 were most commonly encountered. The patients had a median age of 74 years (range 38-93) and were significantly older compared to patients with Staphylococcus aureus-caused IE, (65 years (p = 0.003)). The median time to diagnosis from symptom onset was 1 day for patients with SD-caused IE which was less compared to patients with IE due to the other pathogens (2-15 days). Embolization was seen in 46% and the in-hospital mortality was 8%. Etest-based methods did not indicate any synergy between penicillin and gentamicin whereas synergy was noted for four out of nine isolates applying time-kill assays. This is the largest study of SD-caused IE, a condition with an acute onset predominantly affecting elderly people. Synergy between penicillin and gentamicin against some SD isolates was distinguished but the potential benefit of this must be weighed against the risk of aminoglycoside side effects.


Antibiotic susceptibility; Infective endocarditis; Streptococcus dysgalactiae; emm type


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