Abstract
This study describes coagulase-negative staphylococcal (CoNS) infective endocarditis (IE) epidemiology at our institution, the antibiotic susceptibility profile, and the influence of vancomycin minimum inhibitory concentration (MIC) on patient outcomes. One hundred and three adults with definite IE admitted to an 850-bed tertiary care hospital in Barcelona from 1995-2008 were prospectively included in the cohort. We observed that CoNS IE was an important cause of community-acquired and healthcare-associated IE; one-third of patients involved native valves. Staphylococcus epidermidis was the most frequent species, methicillin-resistant in 52% of patients. CoNS frozen isolates were available in 88 patients. Vancomycin MICs of 2.0 μg/mL were common; almost all cases were found among S. epidermidis isolates and did not increase over time. Eighty-five patients were treated either with cloxacillin or vancomycin: 38 patients (Group 1) were treated with cloxacillin, and 47 received vancomycin; of these 47, 27 had CoNS isolates with a vancomycin MIC <2.0 μg/mL (Group 2), 20 had isolates with a vancomycin MIC ≥2.0 μg/mL (Group 3). One-year mortality was 21%, 48%, and 65% in Groups 1, 2, and 3, respectively (P=0.003). After adjusting for confounders and taking Group 2 as a reference, methicillin-susceptibility was associated with lower 1-year mortality (OR 0.12, 95% CI 0.02-0.55), and vancomycin MIC ≥2.0 μg/mL showed a trend to higher 1-year mortality (OR 3.7, 95% CI 0.9-15.2; P=0.069). Other independent variables associated with 1-year mortality were heart failure (OR 6.2, 95% CI 1.5-25.2) and pacemaker lead IE (OR 0.1, 95%CI 0.02-0.51). In conclusion, methicillin-resistant S.epidermidis was the leading cause of CoNS IE, and patients receiving vancomycin had higher mortality rates than those receiving cloxacillin; mortality was higher among patients having isolates with vancomycin MICs ≥2.0 μg/mL.
Highlights
Coagulase-negative staphylococci (CoNS) have come to be recognized as important, commonly isolated pathogens [1,2]
Median vegetation size was greatest in intracardiac device (ICD) infective endocarditis (IE) (P = 0.007); perivalvular abscesses were most common among patients with prosthetic valve endocarditis (PVE) (P
Mortality rates were similar within the native valve endocarditis (NVE) and PVE groups and lowest among patients with ICD IE (P
Summary
Coagulase-negative staphylococci (CoNS) have come to be recognized as important, commonly isolated pathogens [1,2]. CoNS cause >10% of all infective endocarditis (IE) cases [4] and are among the most frequent etiological agents of intracardiac prosthetic device infections, such as prosthetic valve endocarditis (PVE) and intracardiac device (ICD) endocarditis [5,6,7]. These microorganisms are becoming an important cause of native valve endocarditis (NVE) [8]. The emergence of CoNS with reduced susceptibility to vancomycin [3], together with the increasing prevalence of glycopeptide-intermediate Staphylococcus epidermidis (GISE) [11] and resistance to rifampin and gentamicin among methicillin-resistant S. epidermidis (MRSE), limits therapeutic options and warrants investigation of alternative bactericidal agents
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