Abstract 4370316: Group B Streptococcus Endocarditis: A Systematic Review Reveals High Mortality Despite Aggressive Medical and Surgical Management

Background: Streptococcus agalactiae, also known as Group B streptococcus (GBS), is an uncommon but highly virulent cause of Infective Endocarditis (IE). It is associated with elevated mortality and morbidity given its rapidly destructive nature, and no treatment guidelines currently exist. Here we present the largest systematic review to date regarding this pathogen causing Infective Endocarditis. Research Question: What are the key demographics, characteristics, complications, and management strategies in groups with GBS? Are there differences in medico-surgical vs medical management in these patients? Methods: A systematic literature review was conducted with: “Group B Streptococcus” AND “Infective Endocarditis”. All types of GBS and IE were included. Studies were excluded if no IE was present or duplicated. Key variables such as underlying medical conditions, types of complications, antibiotic type and length of treatment, type and timing of surgery, type of valvular involvement, median days till recovery or death were collected. The data was stratified for differences in medical and medico-surgical groups. Results: A total of 71 (50.3%M 50.6%F) cases were identified that met inclusion and exclusion criteria. Most common underlying medical conditions were Diabetes Mellitus (15.5%) followed by alcohol use disorder (12.6%), and hypertension (12.6%). Various complications were noted with Heart Failure being the most common (22.5%), Septic Emboli (15.4%), Septic Shock (14.1%). Antibiotics most commonly used were beta lactams (85.9%), aminoglycosides (48%) in combination with beta lactams. Surgeries most commonly performed were Mitral Valve Replacement (36.6%), Aortic Valve Replacement (23%), Homograft Root Replacement (10%). Time to surgery median was 12.5 days. Cumulative mortality rate overall was 42.2% (30 patients). Medico-surgical group mortality rate was 41.6% whereas medical group mortality was 42.8% (15 patients), with early surgery (< 9 days) rate at 42.8%. Combination aminoglycoside and beta lactam antibiotic alone showed 48.1% mortality. Conclusions: GBS endocarditis remains a rare but aggressive infection marked by high complication and mortality rates, regardless of treatment approach. While both medical and medico-surgical management show similarly poor outcomes, the lack of clear survival advantage with early surgery or specific antibiotic regimens highlights the urgent need for standardized treatment guidelines.