P0494 - Association Between Enterococcus faecalis Infections and Colorectal Neoplasia: A Systematic Review and Meta-Analysis

Muhammad Waqar Elahi, MD¹, Hira Hameed, MD², Mehran Ali Khan, MBBS³, Waqas Ali, MD¹, Dawood Khan, MD⁴, Ibrahim Sayyid, MD¹, Farhan Israr, MD⁴, Arooj Fatima, MD⁵, Sharath Rajagopalan, MD¹, Aamer Ahmad, MD⁴, Ahmad Khan, ⁴, Shahryar Khan, MD⁶
1West Virginia University School of Medicine, Morgantown, WV; 2Jinnah Hospital Lahore, Lahore, Punjab, Pakistan; 3Khyber Medical University, Nowshera, North-West Frontier, Pakistan; 4Khyber Medical University, Peshawar, North-West Frontier, Pakistan; 5Khyber Medical University, Morgantown, WV; 6University of Kansas Medical Center, Kansas City, KS

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:
- Higher CRN in patients with unknown infection source: 60.08% vs. 49.43% (known source).
- Endocarditis cases had a pooled CRN incidence of 69.13% vs. 36.64% in bacteremia.
- 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.

Discussion: 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.

Disclosures:
Muhammad Waqar Elahi indicated no relevant financial relationships.
Hira Hameed indicated no relevant financial relationships.
Mehran Ali Khan indicated no relevant financial relationships.
Waqas Ali indicated no relevant financial relationships.
Dawood Khan indicated no relevant financial relationships.
Ibrahim Sayyid indicated no relevant financial relationships.
Farhan Israr indicated no relevant financial relationships.
Arooj Fatima indicated no relevant financial relationships.
Sharath Rajagopalan indicated no relevant financial relationships.
Aamer Ahmad indicated no relevant financial relationships.
Ahmad Khan indicated no relevant financial relationships.
Shahryar Khan indicated no relevant financial relationships.

Muhammad Waqar Elahi, MD¹, Hira Hameed, MD², Mehran Ali Khan, MBBS³, Waqas Ali, MD¹, Dawood Khan, MD⁴, Ibrahim Sayyid, MD¹, Farhan Israr, MD⁴, Arooj Fatima, MD⁵, Sharath Rajagopalan, MD¹, Aamer Ahmad, MD⁴, Ahmad Khan, ⁴, Shahryar Khan, MD⁶. P0494 - Association Between <i>Enterococcus faecalis</i> Infections and Colorectal Neoplasia: A Systematic Review and Meta-Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.