Staphylococcus aureus endocarditis: a consequence of medical progress.
BACKGROUND
The global significance of infective endocarditis (IE) caused by Staphylococcus aureus is unknown.


OBJECTIVE
To document the international emergence of health care-associated S aureus IE and methicillin-resistant S aureus (MRSA) IE and to evaluate regional variation in patients with S aureus IE.


METHODS
Prospective observational cohort study set in 39 medical centers in 16 countries. Participants were a population of 1779 patients with definite IE as defined by Duke criteria who were enrolled in the International Collaboration on Endocarditis-Prospective Cohort Study from June 2000 to December 2003.


METHODS
In-hospital mortality.


RESULTS
S aureus was the most common pathogen among the 1779 cases of definite IE in the International Collaboration on Endocarditis Prospective-Cohort Study (558 patients, 31.4%). Health care-associated infection was the most common form of S aureus IE (218 patients, 39.1%), accounting for 25.9% (Australia/New Zealand) to 54.2% (Brazil) of cases. Most patients with health care-associated S aureus IE (131 patients, 60.1%) acquired the infection outside of the hospital. MRSA IE was more common in the United States (37.2%) and Brazil (37.5%) than in Europe/Middle East (23.7%) and Australia/New Zealand (15.5%, P<.001). Persistent bacteremia was independently associated with MRSA IE (odds ratio, 6.2; 95% confidence interval, 2.9-13.2). Patients in the United States were most likely to be hemodialysis dependent, to have diabetes, to have a presumed intravascular device source, to receive vancomycin, to be infected with MRSA, and to have persistent bacteremia (P<.001 for all comparisons).


CONCLUSIONS
S aureus is the leading cause of IE in many regions of the world. Characteristics of patients with S aureus IE vary significantly by region. Further studies are required to determine the causes of regional variation.
Duke University Medical Center, Durham, NC 27710, USA. vance.fowler@duke.edu
Vance G
VG
Fowler
Jose M
JM
Miro
Bruno
B
Hoen
Christopher H
CH
Cabell
Elias
E
Abrutyn
Ethan
E
Rubinstein
G Ralph
GR
Corey
Denis
D
Spelman
Suzanne F
SF
Bradley
Bruno
B
Barsic
Paul A
PA
Pappas
Kevin J
KJ
Anstrom
Dannah
D
Wray
Claudio Q
CQ
Fortes
Ignasi
I
Anguera
Eugene
E
Athan
Philip
P
Jones
Jan T M
JT
van der Meer
Tom S J
TS
Elliott
Donald P
DP
Levine
Arnold S
AS
Bayer
D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D004697:Endocarditis, Bacterial / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D014943:Global Health; D017052:Hospital Mortality; D006801:Humans; D016106:Methicillin Resistance; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D013211:Staphylococcus aureus / Q000187:drug effects