Predictors of death and impact of surgery in Staphylococcus aureus infective endocarditis.
BACKGROUND
We studied a large cohort of adults with Staphylococcus aureus infective endocarditis to evaluate the predictors of outcome and to establish whether early surgery is associated with reduced mortality.


METHODS
The study prospectively enrolled 116 consecutive patients with definite S. aureus infective endocarditis, according to Duke criteria and examined by transthoracic and transesophageal echocardiography.


RESULTS
The in-hospital mortality rate was 26%, and the 36-month survival rate was 57% +/- 5%. Multivariate analyses identified comorbidity index, congestive heart failure, severe sepsis, prosthetic valve infective endocarditis, and major neurologic events as predictors of in-hospital mortality; severe sepsis and comorbidity index as predictors of overall mortality; and the comorbidity index as a predictor of late mortality. In unadjusted analyses, early surgery performed in 47% of patients was associated with lower in-hospital mortality (16% versus 34%; p = 0.034) and with better 36-month survival (77% +/- 6% versus 39% +/- 7%; p < 0.001). After adjustment of baseline variables related to mortality, early surgery remained associated with reduced overall mortality.


CONCLUSIONS
Prognosis of S. aureus infective endocarditis remains poor, related to the comorbidities, presence of congestive heart failure, severe sepsis, major neurologic events, and prosthetic valve. Early surgery is independently associated with reduced overall mortality and should be considered in selected cases to improve the outcome.
Remadi
Jean Paul
JP
Department of Cardiovascular Disease, INSERM, ERI-12 CHU, Amiens, France.
Habib
Gilbert
G
Nadji
Georges
G
Brahim
Amel
A
Thuny
Franck
F
Casalta
Jean Paul
JP
Peltier
Marcel
M
Tribouilloy
Christophe
C
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures / Q000379:methods / Q000401:mortality*; D002423:Cause of Death; D017548:Echocardiography, Transesophageal; D004697:Endocarditis, Bacterial / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D013211:Staphylococcus aureus / Q000302:isolation & purification; D016019:Survival Analysis; D013997:Time Factors
D000900:Anti-Bacterial Agents