Staphylococcus aureus native valve infective endocarditis: report of 566 episodes from the International Collaboration on Endocarditis Merged Database.
BACKGROUND
Staphylococcus aureus native valve infective endocarditis (SA-NVIE) is not completely understood. The objective of this investigation was to describe the characteristics of a large, international cohort of patients with SA-NVIE.


METHODS
The International Collaboration on Endocarditis Merged Database (ICE-MD) is a combination of 7 existing electronic databases from 5 countries that contains data on 2212 cases of definite infective endocarditis (IE).


RESULTS
Of patients with native valve IE, 566 patients [corrected] had IE due to S. aureus, and 1074 patients had IE due to pathogens other than S. aureus (non-SA-NVIE). Patients with S. aureus IE were more likely to die (20% vs. 12%; P < .001), to experience an embolic event (61% [corrected] vs. 31%; P < .001), or to have a central nervous system event (21% [corrected] vs. 13%; P < .001) and were less likely to undergo surgery (26% vs. 39%; P < .001) than were patients with non-SA-NVIE. Multivariate analysis of prognostic factors of mortality identified age (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.1-1.7), periannular abscess (OR, 2.4; 95% CI, 1.0 [corrected] -5.6), heart failure (OR, 3.9; 95% CI, 2.3-6.7), and absence of surgical therapy (OR, 2.3; 95% CI, 1.3-4.2) as variables that were independently associated with mortality in patients with SA-NVIE. After adjusting for patient-, pathogen-, and treatment-specific characteristics by multivariate analysis, geographical region was also found to be associated with mortality in patients with SA-NVIE (P < .001).


CONCLUSIONS
S. aureus is an important and common cause of IE. The outcome of SA-NVIE is worse than that of non-SA-NVIE. Several clinical parameters are independently associated with mortality for patients with SA-NVIE. The clinical characteristics and outcome of SA-NVIE vary significantly by geographic region, although the reasons for such regional variations in outcomes of SA-NVIE are unknown and are probably multifactorial. A large, prospective, multinational cohort study of patients with IE is now under way to further investigate these observations.
Miro
José M
JM
Hospital Clinic Institut d'Investigacions Biomediques August Pi i Sunyer, University of Barcelona, Barcelona, Spain. jmmiro@ub.edu
Anguera
Ignasi
I
Cabell
Christopher H
CH
Chen
Anita Y
AY
Stafford
Judith A
JA
Corey
G Ralph
GR
Olaison
Lars
L
Eykyn
Susannah
S
Hoen
Bruno
B
Abrutyn
Elias
E
Raoult
Didier
D
Bayer
Arnold
A
Fowler
Vance G
VG
D019992:Databases as Topic; D004697:Endocarditis, Bacterial / Q000453:epidemiology* / Q000382:microbiology*; D006801:Humans; D016106:Methicillin Resistance; D011379:Prognosis; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology*; D013211:Staphylococcus aureus