S542 Association Between Enterococcus faecalis Infections and Colorectal Neoplasia: A Systematic Review and Meta-Analysis

Introduction: Enterococcus faecalis is a common cause of bacteremia and infective endocarditis (IE), particularly in elderly or hospitalized patients. While Streptococcus gallolyticus is strongly associated with colorectal neoplasia (CRN), the link between E. faecalis infection and colorectal pathology remains underexplored. This meta-analysis aims to quantify the incidence of CRN in patients with E. faecalis infections and assess how infection type or source influences this relationship. Methods: Following PRISMA 2020 guidelines, we searched PubMed, Scopus, and the Cochrane Library (2010–2025) for studies evaluating CRN in patients with E. faecalis bacteremia or IE. Seven studies (n = 2,080) met the inclusion criteria. Outcomes included the incidence of CRN, subgroup analysis by infection source (known vs unknown), infection type, and study design. Meta-analyses were conducted using fixed- or random-effects models based on heterogeneity. The risk of bias was assessed using the PROBAST tool. Results: The overall pooled incidence of CRN was 13.43% (95% CI: 11.71%–15.75%; I² = 96.6%). After excluding one highly weighted study during sensitivity analysis, incidence increased to 39.42% (95% CI: 34.76%–44.08%; I² = 86.0%). Subgroup analysis revealed: (1) Higher CRN in patients with unknown infection source: 60.08% vs 49.43% (known source). (2) Endocarditis cases had a pooled CRN incidence of 69.13% vs 36.64% in bacteremia. (3) Retrospective studies reported higher incidence (46.66%) than prospective ones (35.41%). Funnel plot and Egger’s/Begg’s tests indicated no significant publication bias. Conclusion: Patients with E. faecalis endocarditis or bacteremia especially those without a known infection source exhibit a high incidence of colorectal neoplasia. These findings support routine colonoscopy screening in this population and suggest a possible oncogenic role of E. faecalis, warranting further research.