title: Epidemiology and prognosis of coagulase-negative staphylococcal endocarditis: impact of vancomycin minimum inhibitory concentration.
abstract: This study describes coagulase-negative staphylococcal (CoNS) infective endocarditis (IE) epidemiology at our institution, the antibiotic susceptibility profile, and the influence of vancomycin minimum inhibitory concentration (MIC) on patient outcomes. One hundred and three adults with definite IE admitted to an 850-bed tertiary care hospital in Barcelona from 1995-2008 were prospectively included in the cohort. We observed that CoNS IE was an important cause of community-acquired and healthcare-associated IE; one-third of patients involved native valves. Staphylococcus epidermidis was the most frequent species, methicillin-resistant in 52% of patients. CoNS frozen isolates were available in 88 patients. Vancomycin MICs of 2.0 μg/mL were common; almost all cases were found among S. epidermidis isolates and did not increase over time. Eighty-five patients were treated either with cloxacillin or vancomycin: 38 patients (Group 1) were treated with cloxacillin, and 47 received vancomycin; of these 47, 27 had CoNS isolates with a vancomycin MIC <2.0 μg/mL (Group 2), 20 had isolates with a vancomycin MIC ≥ 2.0 μg/mL (Group 3). One-year mortality was 21%, 48%, and 65% in Groups 1, 2, and 3, respectively (P = 0.003). After adjusting for confounders and taking Group 2 as a reference, methicillin-susceptibility was associated with lower 1-year mortality (OR 0.12, 95% CI 0.02-0.55), and vancomycin MIC ≥ 2.0 μg/mL showed a trend to higher 1-year mortality (OR 3.7, 95% CI 0.9-15.2; P=0.069). Other independent variables associated with 1-year mortality were heart failure (OR 6.2, 95% CI 1.5-25.2) and pacemaker lead IE (OR 0.1, 95%CI 0.02-0.51). In conclusion, methicillin-resistant S.epidermidis was the leading cause of CoNS IE, and patients receiving vancomycin had higher mortality rates than those receiving cloxacillin; mortality was higher among patients having isolates with vancomycin MICs ≥ 2.0 μg/mL.
authors.affiliation: Infectious Diseases Service, The Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona School of Medicine, Barcelona, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: García de la Mària
authors.affiliation: Infectious Diseases Service, The Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona School of Medicine, Barcelona, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Cervera
authors.affiliation: Infectious Diseases Service, The Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona School of Medicine, Barcelona, Spain.
authors.forename: Juan M
authors.initials: JM
authors.lastname: Pericàs
authors.affiliation: Infectious Diseases Service, The Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona School of Medicine, Barcelona, Spain.
authors.forename: Ximena
authors.initials: X
authors.lastname: Castañeda
authors.affiliation: Infectious Diseases Service, The Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona School of Medicine, Barcelona, Spain.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Armero
authors.affiliation: Pharmacy Service, The Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona School of Medicine, Barcelona, Spain.
authors.forename: Dolors
authors.initials: D
authors.lastname: Soy
authors.affiliation: Microbiology Service, The Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona School of Medicine, Barcelona, Spain.
authors.forename: Manel
authors.initials: M
authors.lastname: Almela
authors.affiliation: Department of Cardiovascular Surgery, The Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona School of Medicine, Barcelona, Spain.
authors.forename: Salvador
authors.initials: S
authors.lastname: Ninot
authors.affiliation: Cardiology Service, The Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona School of Medicine, Barcelona, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Falces
authors.affiliation: Department of Cardiovascular Surgery, The Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona School of Medicine, Barcelona, Spain.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Mestres
authors.affiliation: Infectious Diseases Service, The Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona School of Medicine, Barcelona, Spain.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Gatell
authors.affiliation: Infectious Diseases Service, The Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona School of Medicine, Barcelona, Spain.
authors.forename: Asuncion
authors.initials: A
authors.lastname: Moreno
authors.affiliation: Microbiology Service, The Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona School of Medicine, Barcelona, Spain.
authors.forename: Francesc
authors.initials: F
authors.lastname: Marco
authors.affiliation: Infectious Diseases Service, The Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona School of Medicine, Barcelona, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Miró
mesh_terms: D000328:Adult; D000368:Aged; D003030:Coagulase / Q000172:deficiency*; D015897:Comorbidity; D024881:Drug Resistance, Bacterial; D004697:Endocarditis, Bacterial / Q000453:epidemiology* / Q000382:microbiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D016106:Methicillin Resistance; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009026:Mortality; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D011446:Prospective Studies; D013030:Spain / Q000453:epidemiology; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology*; D013210:Staphylococcus / Q000187:drug effects / Q000201:enzymology* / Q000302:isolation & purification; D014640:Vancomycin / Q000494:pharmacology
chemical_list: D003030:Coagulase; D014640:Vancomycin