Abiotrophia defectiva infective endocarditis: a systematic review of published case reports
- 1Cardiovascular Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University
Abstract
Background: Abiotrophia defectiva (AD), a fastidious and virulent pathogen, rarely causes infective endocarditis (IE). AD-related IE, termed ADIE, remains poorly characterized due to limited robust clinical data. This study synthesizes global case reports to clarify the characteristics and management of ADIE.
Methods: We systematically searched PubMed, Web of Science, CNKI, VIP Database, and Wanfang databases up to October 28, 2025. Definitive ADIE cases meeting the IE criteria at the time of publication and with microbiological confirmation of AD were included. The 2023 European Society of Cardiology (ESC) IE diagnostic criteria were reapplied to assess potential bias. Patient-level data were extracted and analyzed descriptively.
Results: Fifty-four patients (from 51 articles) had a median age of 36.6 years (IQR 16.0–53.5), 61.1% were male. Underlying cardiovascular disease (42.6%, 22.2% congenital) and a history of oral procedure or infection (27.8%) were common. Mitral valve involvement was most frequent (59.3%). Misdiagnosis or diagnostic delay occurred in 18.5% of cases. Among patients who received both transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE), TEE detected vegetations missed by TTE in 20.0%. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry identified AD in 16.7% of cases. Recovery was documented in 21/21 patients whose regimens included vancomycin; however, all received combination therapy and/or surgery, and none received vancomycin monotherapy, so the independent effect of vancomycin could not be assessed. The most frequently used regimen was a β-lactam plus gentamicin, with documented recovery in 27/28 patients (96.4%); this proportion is descriptive only and cannot be attributed to the regimen itself. Overall, 70.4% underwent surgery (66.7% cardiac surgery; 5.6% craniocerebral surgery, with one overlap). Only one in-hospital death was recorded among the published cases because of poor general condition.
Conclusions: ADIE predominantly affects young males and a history of heart disease or oral procedures and is frequently misdiagnosed. Diagnosis is aided by TEE, blood cultures, and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Although surgical rates are high, reported short-term outcomes in published cases appear favorable, this evidence is of very low certainty because of publication, reporting, and survival bias, and long-term outcome data remain inadequate.
Related
- Prevalence, risk factors, and outcomes of infective endocarditis in people living with HIV: A systematic review and meta-analysis of intravenous drug use and microbiological profiles.
- Diagnostic Yield and Incremental Value of 16S rRNA Gene PCR and Sequencing on Excised Heart-Valve Tissue in Infective Endocarditis: A Systematic Review and Meta-Analysis.
- Enterococcus faecalis bacteraemia and infective endocarditis: a systematic review and meta-analysis.
- Antibiotic Prophylaxis of Infective Endocarditis in Dentistry: An Update on the ESC, AHA, and NICE Guidelines
- Robotic tricuspid valve repair for infective endocarditis with leaflet perforation and severe tricuspid regurgitation
BibTeX
@article{xiang2026abiotrophia,
title = {{Abiotrophia defectiva infective endocarditis: a systematic review of published case reports}},
author = {Wei Xiang and Lintao Mu and Minghuan Hong and Maxwell Ahiafor and Lingyun Kong and Li Fu and Lingling Chen and Jiaxin Cao and Xinlong Gao and Fang Liu},
journal = {Frontiers in Cardiovascular Medicine},
year = {2026},
month = nov,
doi = {10.3389/fcvm.2026.1942577},
url = {https://www.frontiersin.org/articles/10.3389/fcvm.2026.1942577/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Abiotrophia defectiva infective endocarditis: a systematic review of published case reports
AU - Wei Xiang
AU - Lintao Mu
AU - Minghuan Hong
AU - Maxwell Ahiafor
AU - Lingyun Kong
AU - Li Fu
AU - Lingling Chen
AU - Jiaxin Cao
AU - Xinlong Gao
AU - Fang Liu
PY - 2026
DA - 2026/11/09
JO - Frontiers in Cardiovascular Medicine
DO - 10.3389/fcvm.2026.1942577
UR - https://www.frontiersin.org/articles/10.3389/fcvm.2026.1942577/full
AB - Background: Abiotrophia defectiva (AD), a fastidious and virulent pathogen, rarely causes infective endocarditis (IE). AD-related IE, termed ADIE, remains poorly characterized due to limited robust clinical data. This study synthesizes global case reports to clarify the characteristics and management of ADIE. Methods: We systematically searched PubMed, Web of Science, CNKI, VIP Database, and Wanfang databases up to October 28, 2025. Definitive ADIE cases meeting the IE criteria at the time of publication and with microbiological confirmation of AD were included. The 2023 European Society of Cardiology (ESC) IE diagnostic criteria were reapplied to assess potential bias. Patient-level data were extracted and analyzed descriptively. Results: Fifty-four patients (from 51 articles) had a median age of 36.6 years (IQR 16.0–53.5), 61.1% were male. Underlying cardiovascular disease (42.6%, 22.2% congenital) and a history of oral procedure or infection (27.8%) were common. Mitral valve involvement was most frequent (59.3%). Misdiagnosis or diagnostic delay occurred in 18.5% of cases. Among patients who received both transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE), TEE detected vegetations missed by TTE in 20.0%. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry identified AD in 16.7% of cases. Recovery was documented in 21/21 patients whose regimens included vancomycin; however, all received combination therapy and/or surgery, and none received vancomycin monotherapy, so the independent effect of vancomycin could not be assessed. The most frequently used regimen was a β-lactam plus gentamicin, with documented recovery in 27/28 patients (96.4%); this proportion is descriptive only and cannot be attributed to the regimen itself. Overall, 70.4% underwent surgery (66.7% cardiac surgery; 5.6% craniocerebral surgery, with one overlap). Only one in-hospital death was recorded among the published cases because of poor general condition. Conclusions: ADIE predominantly affects young males and a history of heart disease or oral procedures and is frequently misdiagnosed. Diagnosis is aided by TEE, blood cultures, and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Although surgical rates are high, reported short-term outcomes in published cases appear favorable, this evidence is of very low certainty because of publication, reporting, and survival bias, and long-term outcome data remain inadequate.
SN - 2297-055X
ER -