Microbiological and Epidemiological Aspects of Endocarditis Caused by Rothia spp.: A Systematic Review

Background and Aim: Rothia, a genus comprising pleomorphic Gram-positive bacteria found in the human oral, intestinal, and skin microbiota, is recognized as an opportunistic pathogen. Case reports of Rothia spp. endocarditis in the scientific literature are scarce, with limited knowledge of relevant data on Rothia endocarditis and clinical aspects of its treatment. The objective of this literature review is to compile clinical aspects of endocarditis caused by Rothia species, analyzing results and clinical practices to elucidate the most important risk factors, comorbidities, prognostic factors, and appropriate antibiotic treatment options.

Methods: Employing the PRISMA model, a systematic review was conducted utilizing PubMed, SciELO, and Google Scholar databases, encompassing articles published from 1978 to November 2023. Pertinent aspects were systematically recorded and summarized for subsequent analysis.

Results: Rothia dentocariosa (48.69%), Rothia mucilaginosa (22.37%), Rothia aeria (14.47%), and Rothia kristinae (14.47%) were recognized as the agents of endocarditis cases. Patients exhibited an average age of 48.5 years, with a notable male preponderance (71.6%). Clinical manifestations of Rothia spp. endocarditis presented similar features compared to other Gram-positive bacterial endocarditis cases. The mortality rate was notably lower than observed in other infectious endocarditis instances (11.84%). Predominant risk factors included preexisting cardiovascular diseases (50%), followed by odontological procedures, caries, and precarious oral hygiene (17.1%), immunocompromised status (14.47%), injectable illicit drug use (11.84%), and diabetes (9.21%). Embolic events were documented in 35.53% of patients, predominantly in Central Nervous System (28.95%). Mycotic aneurysms were identified in 6.58% of cases. Resistance to antibiotics was identified in only 13.16% of strains causing endocarditis, although certain strains displayed characteristics indicative of multidrug resistance.

Conclusion: Despite its rarity, Rothia spp. endocarditis exhibits clinical parallels with endocarditis caused by other Gram-positive bacteria, but with a comparatively lower mortality rate. Challenges in identifying Rothia spp. species based on cultural and microscopic characteristics, associated to early resolution in antibiotic therapy, seems to contribute to the underreporting of endocarditis caused by these bacteria.