title: Risk of endocarditis among patients with prosthetic valves and Staphylococcus aureus bacteremia.
abstract: OBJECTIVE
  Staphylococcus aureus is a common cause of bacteremia and of native valve infective endocarditis. However, the risk of endocarditis in patients with a prosthetic valve who develop S. aureus bacteremia is unclear. The aim of this study was to define the risk of prosthetic valve endocarditis in patients with S. aureus bacteremia.
  
  
  METHODS
  All patients with a prosthetic valve or ring who developed S. aureus bacteremia during the 94-month study period were prospectively evaluated. The modified Duke criteria were used for the diagnosis of endocarditis. Patients were followed up for 12 weeks after the initial diagnosis of S. aureus bacteremia.
  
  
  RESULTS
  The overall rate of definite prosthetic valve endocarditis among the study patients was 26/51 (51%). The risk of endocarditis was similar in patients with late (>or=12 months after valve implantation) vs. early S. aureus bacteremia (<12 months after prosthetic valve implantation) (50% vs. 52%, P=1.0), mitral vs. aortic prostheses (62% vs. 48%, P=0.24), and mechanical vs. bioprosthetic valves (62% vs. 44%, P=0.29). The 12-week mortality was higher among patients with definite vs. possible endocarditis (62% vs. 28%, P=0.019).
  
  
  CONCLUSIONS
  In this investigation, approximately half of all patients with prosthetic valves who developed S. aureus bacteremia had definite endocarditis. The risk of endocarditis was independent of the type, location, or age of the prosthetic valve. The mortality of prosthetic valve endocarditis is high. All patients with a prosthetic valve who develop S. aureus bacteremia should be aggressively screened and followed for endocarditis.
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors.forename: Fadi
authors.initials: F
authors.lastname: El-Ahdab
authors.forename: Daniel Kelly
authors.initials: DK
authors.lastname: Benjamin
authors.forename: Andrew
authors.initials: A
authors.lastname: Wang
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Cabell
authors.forename: Vivian H
authors.initials: VH
authors.lastname: Chu
authors.forename: Martin E
authors.initials: ME
authors.lastname: Stryjewski
authors.forename: G Ralph
authors.initials: GR
authors.lastname: Corey
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Sexton
authors.forename: L Barth
authors.initials: LB
authors.lastname: Reller
authors.forename: Vance G
authors.initials: VG
authors.lastname: Fowler
mesh_terms: D016470:Bacteremia / Q000382:microbiology*; D004697:Endocarditis, Bacterial / Q000382:microbiology* / Q000401:mortality; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects* / Q000382:microbiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000382:microbiology*; D013203:Staphylococcal Infections / Q000401:mortality; D013211:Staphylococcus aureus