Introduction:
Infective endocarditis (IE) caused by Staphylococcus species have been noted to increase and are believed to be associated with higher morbidity and mortality rates.
Hypothesis:
Staphylococcus species are more virulent compared to other commonly causative bacteria of IE.
Methods:
The database of the Clinical Multicenter Project for Analysis of Infective Endocarditis in Germany (CAMPAIGN), comprising 4917 consecutive patients (mean age 62.2±14.6 years) undergoing heart valve surgery, was retrospectively analyzed. Uni- and multivariable regression analyses were used for comparison and risk stratification. The Kaplan Meier method was used for long-term survival estimation of the respective groups.
Results:
Staphylococcus patients (n=1260) were significantly more morbid than the Non-Staphylocccus group (n=3657) with regard to NYHA IV (21.4% vs. 16.7%*), CAD (29.0% vs. 25.7%;
p
=0.027), arterial hypertension (64.8% vs. 45.8%*), diabetes (29.9% vs. 24.8%*), renal failure (47.5% vs. 35.2%*), COPD (12.8% vs. 9.9%;
p
=0.007), PAD (11.3% vs. 6.4%*), preoperative stroke (35.1% vs. 18.0%*) and need for mechanical ventilation (18.2% vs. 6.4%*). Overall, Staphylococcus infections were more prevalent on mitral (51.0% vs. 42.0%*) and tricuspid (9.4% vs. 4.4%*) valves and showed higher incidences of large vegetations (87.0% vs. 56.0%*), mitral regurgitation (62.5% vs. 41.5%*) and preoperative septic embolism (51.8% vs. 28.9%*). Postoperatively, need for tracheostomy (13.7% vs. 7.6%*) and dialysis (29.4% vs. 13.6%*) were also significantly increased. The 30-day mortality for Staphylococcus was significantly higher (21.3% vs. 15.9%*) and long-term survival was significantly worse (
Fig. 1
).
Conclusions:
Staphylococcus endocarditis is associated with significantly worse outcome compared to IE by other commonly causative bacteria. Early surgery should be considered to avoid preoperative septic embolism, deterioration and death.
*=
p
<0.0001
OCCULT SEPTIC EMBOLISM: A CARDIOVASCULAR SHOWER TO THE BRAIN
