Abstract
BackgroundAs Staphylococcus aureus (SA) remains one of the leading cause of infective endocarditis (IE), this study evaluates whether S. aureus is associated with more severe infections or worsened outcomes compared to non-S. aureus (NSA) organisms.MethodsAll patients undergoing valve surgery for bacterial IE between 1995 and 2013 at our institution were included in this study (n = 323). Clinical data were retrospectively collected from the chart review. Patients were stratified according to the causative organism; SA (n = 85) and NSA (n = 238). Propensity score matched pairs (n = 64) of SA versus NSA were used in the analysis.ResultsSA patients presented with more severe IE compared to NSA patients, with higher rates of preoperative vascular complications, preoperative septic shock, preoperative embolic events, preoperative stroke, and annular abscess. Among the matched pairs, there were no significant differences in 30-day (9.4% SA vs. 7.8% NSA, OR = 1.20, p = 0.76) or 1-year mortality (20.3% SA vs. 14.1% NSA, OR = 1.57, p = 0.35) groups, though late survival was significantly worse in SA patients. There was also no significant difference in postoperative morbidity between the two matched groups.ConclusionsSA IE is associated with a more severe clinical presentation than IE caused by other organisms. Despite the clearly increased preoperative risk, valvular surgery may benefit SA IE patients by moderating the post-operative mortality and morbidity.
Highlights
As Staphylococcus aureus (SA) remains one of the leading cause of infective endocarditis (IE), this study evaluates whether S. aureus is associated with more severe infections or worsened outcomes compared to non-S. aureus (NSA) organisms
46% of patients had a history of prior cardiac surgery, with 23% presenting with a history of valve replacement within the last 5 years
More patients in the SA group had a past medical history of intravenous drug use (10.6% SA vs. 2.9% NSA, p = 0.005), and there was a trend towards higher rates of prior cerebrovascular accident, end-stage renal disease, and prior arrhythmia in the SA group compared to NSA (p = 0.06, p = 0.09, and p = 0.07, respectively)
Summary
As Staphylococcus aureus (SA) remains one of the leading cause of infective endocarditis (IE), this study evaluates whether S. aureus is associated with more severe infections or worsened outcomes compared to non-S. aureus (NSA) organisms. Infective endocarditis (IE) remains a condition associated with high morbidity and mortality rates despite advances in surgical techniques and medical therapy [1]. Staphylococcus aureus (SA) is one of the leading causative organisms of IE, and has shown an increasing prevalence in recent years [2]. Among the many pathogens cultured from patients with IE, SA is concerning as it may be associated with higher mortality rates, ranging from 23 to 45% in published reports [3]. No study has directly investigated the distinct presenting features or postoperative outcomes associated with SA IE compared to NSA in a surgical population requiring valvular replacement. The aim of the current study is to evaluate the clinical presentation of patients with
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