Prosthetic valve endocarditis due to coagulase-negative staphylococci: findings from the International Collaboration on Endocarditis Merged Database
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Infective endocarditis due to coagulase-negative staphylococci is increasingly recognized as a difficult-to-treat disease associated with poor outcome. The aim of this report is to describe the characteristics and outcome of patients with prosthetic valve endocarditis (PVE) due to coagulase-negative staphylococci versus those of patients with PVE due to Staphylococcus aureus and viridans streptococci. Patients were identified through the International Collaboration on Endocarditis Merged Database. A total of 54 cases of coagulase-negative staphylococci PVE, 58 cases of S. aureus PVE, and 63 cases of viridans-streptococci-related PVE were available for analysis. There was no difference between the three groups with respect to the type of valve involved or the rate of embolization. However, heart failure was encountered more frequently with coagulase-negative staphylococci (54%) than with either S. aureus (33%; p=0.03) or viridans streptococci (32%; p=0.02). In addition, valvular abscesses complicated 39% of infections due to coagulase-negative staphylococci compared with 22% of those due to S. aureus (p=0.06) and 6% of those due to viridans streptococci (p<0.001). Mortality was highest in patients with S. aureus and coagulase-negative staphylococcal endocarditis (47 and 36%, respectively; p=0.22) and was considerably lower in patients with viridans streptococcal endocarditis (p=0.002 compared to patients with coagulase-negative staphylococcal endocarditis). The results of this analysis demonstrate the aggressive nature of coagulase-negative staphylococcal PVE and the substantially greater morbidity and mortality associated with this infection compared to PVE caused by other pathogens.
KeywordsEndocarditis Infective Endocarditis Prosthetic Valve Endocarditis Viridans Streptococcus Viridans Group Streptococcus
This study was supported in part by the National Institutes of Health (grants R01AI59111 [to V.G.F.] and HL70861 [to C.H.C.]) the Tenet Healthcare Foundation (to E.A.), the Red Española de Investigación en Patología Infecciosa (V-2003-REDC14A-O) (to J.M.M.), the Fundación Privada Máximo Soriano Jiménez (to J.M.M.), and the Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona (research grant to J.M.M.).
Members of the International Collaboration on Endocarditis Merged Database (ICE-MD): Barcelona, Spain (Hospital Clinic IDIBAPS): J.M. Miró, A. del Río, M.A. Baraldes, M.J. Jiménez-Expósito, N. de Benito, X. Claramonte, M.E. Díaz, A. Soriano, A. Moreno, J.M. Gatell, F. Marco, C. García de la María, Y. Armero, M. Almela, M.T. Jiménez de Anta, J.C. Paré, M. Azqueta, C.A. Mestres, S. Ninot, R. Cartaña, J.L. Pomar, N. Pérez, J. Ramírez, and R. Ribalta; Besancon/Nancy, France: B. Hoen, C. Selton-Suty, T. Doco-Lecompte, F. Duchêne, N. Khayat, Y. Bernard, and C. Chirouze; Durham, North Carolina, USA: G.R. Corey, D.J. Sexton, V.G. Fowler Jr., C.W. Woods, A. Wang, G.E. Peterson, J.G. Jollis, D.J. Anderson, R. Singh, C.H. Cabell, D. Glower, A. Chen, J. Stafford, K. Anstrom, and P. Pappas; Goteborg, Sweden: L. Olaison and the Swedish Society of Infectious Diseases Quality Assurance Study Group for Endocarditis; London, UK: S. Eykyn; Marseille, France: D. Raoult, G. Habib, J.P. Casalta, K. Barrau, and P.E. Fournier; Philadelphia, Pennsylvania, USA: E. Abrutyn, B.L. Strom, J.A. Berlin, J.L. Kinman, R.S. Feldman, M.E. Levison, O.M. Korzeniowski, and D. Kaye.
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