Infective endocarditis; Staphylococcus aureus versus other pathogens

Abstract

Infective endocarditis (IE) remains a life-threatening disease. Clinical features, epidemiological parameters, and bacteriological profile are changing over the years and necessitate periodical evaluation. To determine clinical, and prognostic features of Staphylococcus aureus infective endocarditis (IE) compared with endocarditis caused by other pathogens. We conducted a prospective study which included 240 patients diagnosed with infective endocarditis (IE) according to the Duke criteria and hospitalized in the cardiology department of Monastir hospital between 1983 and 2017. Patients without identified microorganisms were excluded. The S. aureus IE group ( n = 72) was compared with the group with IE caused by other pathogens ( n = 121). S. aureus IE was characterised by severe co-morbidity, a shorter duration of symptoms before diagnosis, and a higher prevalence of right-sided IE Compared with IE caused by other pathogens. Cutaneous portal of entry, and history of renal failure were more common in S. aureus IE. Severe sepsis, major neurological events, and multiple organ failure were more frequent during the acute phase in S. aureus IE. In-hospital mortality (29% vs. 9%, P < 0.001) was higher in patients with S. aureus IE and the 12 months survival rate was lower in S. aureus IE than in IE caused by other pathogens (51% vs. 69%, P = 0.002). Multivariate analyses identified S. aureus infection as a predictive factor for in-hospital mortality and for overall mortality. S. aureus IE compared with IE caused by other pathogens is characterised by a higher prevalence of severe sepsis, major neurological events and organ failure leading to higher mortality.