• Eur. J. Intern. Med. · Jan 2021

    Observational Study

    Enterococcal infective endocarditis is a marker of current occult or future incident colorectal neoplasia.

    • Maria Paola Ursi, Lorenzo Bertolino, Roberto Andini, Fabiana D'Amico, Domenico Iossa, Arta Karruli, Eugenio D'Avenia, Sabrina Manduca, Mariano Bernardo, Rosa Zampino, and Emanuele Durante-Mangoni.
    • Internal Medicine, University of Campania 'L. Vanvitelli', Via De Crecchio 7, 80138 Napoli, Italy.
    • Eur. J. Intern. Med. 2021 Jan 1; 83: 68-73.

    BackgroundFew studies suggest an association between Enterococcal infective endocarditis (EIE) and colorectal disease, including colorectal neoplasia (CRN) and colorectal cancer (CRC). In this study, we analyze differences in prevalence, risk factors and outcome of CRN and CRC between EIE and Streptococcus gallolyticus infective endocarditis (SGIE).MethodsSingle center, observational study of 166 patients with definite EIE or SGIE. Clinical data were collected prospectively in a standardized IE protocol. Colonoscopy data were collected retrospectively on 90 patients.Results85 patients had EIE, 81 SGIE. EIE patients had a higher rate of prior cancer (20% vs 6%) and health-care associated infection (12% vs 1%), but similar mortality than SGIE. Colonoscopy performed in 90 patients showed intestinal diseases in 30 of 42 (71%) EIE patients vs. 40 of 48 (83%) SGIE patients (p = 0.174), with a predominance of CRN. Among 78 patients who underwent colonoscopy after IE diagnosis, no difference between EIE and SGIE was observed in the rate of non-neoplastic lesions (48% vs 47%), benign (32% vs 40%) or malignant (13% vs 15%) neoplastic lesions. Adverse events during colonoscopy were uncommon, although a careful handling of anticoagulation was required.ConclusionsEIE seems to be associated with colorectal disease, including colorectal neoplasia and colorectal cancer, to the same extent as SGIE. EIE should be considered a marker of colorectal neoplasia, even in patients with a clear health-care related acquisition. Colonoscopy is generally safe in EIE patients, and should be considered to early diagnose and treat colorectal disease.Copyright © 2020 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

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