Impact of early valve surgery on outcome of Staphylococcus aureus prosthetic valve infective endocarditis: analysis in the International Collaboration of Endocarditis-Prospective Cohort Study.
BACKGROUND
The impact of early valve surgery (EVS) on the outcome of Staphylococcus aureus (SA) prosthetic valve infective endocarditis (PVIE) is unresolved. The objective of this study was to evaluate the association between EVS, performed within the first 60 days of hospitalization, and outcome of SA PVIE within the International Collaboration on Endocarditis-Prospective Cohort Study.


METHODS
Participants were enrolled between June 2000 and December 2006. Cox proportional hazards modeling that included surgery as a time-dependent covariate and propensity adjustment for likelihood to receive cardiac surgery was used to evaluate the impact of EVS and 1-year all-cause mortality on patients with definite left-sided S. aureus PVIE and no history of injection drug use.


RESULTS
EVS was performed in 74 of the 168 (44.3%) patients. One-year mortality was significantly higher among patients with S. aureus PVIE than in patients with non-S. aureus PVIE (48.2% vs 32.9%; P = .003). Staphylococcus aureus PVIE patients who underwent EVS had a significantly lower 1-year mortality rate (33.8% vs 59.1%; P = .001). In multivariate, propensity-adjusted models, EVS was not associated with 1-year mortality (risk ratio, 0.67 [95% confidence interval, .39-1.15]; P = .15).


CONCLUSIONS
In this prospective, multinational cohort of patients with S. aureus PVIE, EVS was not associated with reduced 1-year mortality. The decision to pursue EVS should be individualized for each patient, based upon infection-specific characteristics rather than solely upon the microbiology of the infection causing PVIE.
UMR CNRS 6249 Chrono-Environnement, Université de Franche-Comté Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Régional Universitaire, Besançon.
Catherine
C
Chirouze
Université de Lorraine, Université Paris Descartes, Apemac, EA4360 INSERM, CIC-EC, CIE6 CHU Nancy, Pôle S2R, Epidémiologie et Evaluation Cliniques, Nancy, France.
François
F
Alla
Department of Medicine, Duke University Medical Center, Durham, North Carolina.
Vance G
VG
Fowler
Department of Medicine, Duke University Medical Center, Durham, North Carolina.
Daniel J
DJ
Sexton
Department of Medicine, Duke University Medical Center, Durham, North Carolina.
G Ralph
GR
Corey
Department of Medicine, Duke University Medical Center, Durham, North Carolina.
Vivian H
VH
Chu
Department of Medicine, Duke University Medical Center, Durham, North Carolina.
Andrew
A
Wang
INSERM, CIC-EC, CIE6 CHU Nancy, Pôle S2R, Epidémiologie et Evaluation Cliniques, Nancy, France.
Marie-Line
ML
Erpelding
Department of Cardiothoracic Sciences, University of Naples S.U.N., Monaldi Hospital, Italy.
Emanuele
E
Durante-Mangoni
Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain.
Nuria
N
Fernández-Hidalgo
Fourth Department of Internal Medicine, Attikon University General Hospital, Athens, Greece.
Efthymia
E
Giannitsioti
Department of Microbiology, Mater Misericordiae University Hospital, Dublin, Ireland.
Margaret M
MM
Hannan
Department of Infectious Diseases, Medical Centre Ljubljana, Slovenia.
Tatjana
T
Lejko-Zupanc
Hospital Clinic-IDIBAPS, University of Barcelona.
José M
JM
Miró
Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Patricia
P
Muñoz
Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand.
David R
DR
Murdoch
Maladies Infectieuses et Réanimation Médicale, Pontchaillou University Hospital, Rennes.
Pierre
P
Tattevin
Départment de Cardiologie, Hôpital Universitaire Sud, Amiens.
Christophe
C
Tribouilloy
UMR CNRS 6249 Chrono-Environnement, Université de Franche-Comté Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Régional Universitaire, Besançon Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud, EA 4537, Pointe-à-Pitre, Guadeloupe Service de Maladies Infectieuses et Tropicales, CIC 1424, Centre Hospitalier Universitaire, Pointe-à-Pitre, France.
Bruno
B
Hoen
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004696:Endocarditis / Q000382:microbiology / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006351:Heart Valves / Q000601:surgery*; D006801:Humans; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D013203:Staphylococcal Infections / Q000382:microbiology / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D013211:Staphylococcus aureus / Q000302:isolation & purification; D016019:Survival Analysis; D016896:Treatment Outcome
1-year mortality; endocarditis; prosthetic valve; surgery