0031 : Left-sided native valve staphylococcus aureus infective endocarditis – evolution of prognosis

Abstract

Staphylococcus Aureus infective endocarditis (SAIE) remains a serious disease. Our objective is to study the epidemiological, clinical and echographic characteristics and prognostic factors of left-sided native valve SAIE, and compare these characterisctics between 2 periods (1990-2000 vs 2001-2010). It is a retrospective analysis of 162 left-sided native valve SAIE in 1254 patients hospitalized for infective endocarditis (IE) at University Hospitals in Amiens and Marseille between 1990 and 2010. SAIE represents 18% of IE and 22.8% of native valve IE. Complications include heart failure in 44.7% of the cases, acute renal failure in 23.3%, sepsis in 28.5%, neurological events in 35.8%, systemic embolic event in 54.9% and hospital mortality in 25.3%. Factors associated with hospital mortality are comorbidity index (OR=1.2, p=0.04), heart failure (OR=2.5, p=0.04) and sepsis (OR=5.3, p=0.001). Overall mortality is 45.4%±7.2% at 48 months. Factors associated with overall mortality are comorbidity index (OR=1.1, p=0.017), heart failure (OR=1.7, p=0.032), sepsis (OR=3, p=0.0001) and delayed surgery (OR=0.43, p=0.003). The comparison of the 2 periods shows a significant increase in acute renal failure, bivalvular involvement and valvular insufficiency from 2001 to 2010. There was also a non-significant increase in early surgery (39.1% vs 50%, p=0.2). There was no significant difference in hospital mortality rates (28.1% vs 23.5%, p=0.58), in overall mortality at 48 months (48.8% vs 42.9%, p=0.241), and in delayed mortality at 48 months (28.2% vs 23.5%, p=0.225). The mortality due to left-sided native valve SAIE remains elevated. Factors associated with hospital mortality are comorbidity index, heart failure and sepsis. Factors associated with overall mortality are comorbidity index, heart failure, sepsis and delayed surgery. Despite surgical progress, there is no significant decrease in hospital mortality, overall mortality and delayed mortality between the 2 periods.