Comparison of prognoses of Staphylococcus aureus left-sided prosthetic endocarditis and prosthetic endocarditis caused by other pathogens

• Published in: Archives of cardiovascular diseases Vol. 109; no. 10; pp. 542 - 549
• Main Authors: Abdallah, Layal, Habib, Gilbert, Remadi, Jean-Paul, Salaun, Erwan, Casalta, Jean-Paul, Tribouilloy, Christophe
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Masson SAS 01.10.2016; Elsevier/French Society of Cardiology
• Subjects: Aged; Cardiovascular; Echocardiography; Endocardite infectieuse; Endocarditis, Bacterial - diagnosis; Endocarditis, Bacterial - epidemiology; Endocarditis, Bacterial - etiology; Female; France - epidemiology; Heart Valve Prosthesis - adverse effects; Heart Valve Prosthesis - microbiology; Hospital Mortality - trends; Human health and pathology; Humans; Incidence; Infectious diseases; Infective endocarditis; Internal Medicine; Left-sided prosthetic valve; Life Sciences; Male; Middle Aged; Odds Ratio; Prognosis; Pronostic; Prosthesis-Related Infections - diagnosis; Prosthesis-Related Infections - epidemiology; Prosthesis-Related Infections - etiology; Prothèse du cœur gauche; Retrospective Studies; Sepsis; Staphylococcal Infections - diagnosis; Staphylococcal Infections - epidemiology; Staphylococcal Infections - etiology; Staphylococcus aureus; Staphylococcus aureus - isolation & purification; Left-sided prosthetic valve; non- Staphylococcus aureus prosthetic infective endocarditis (prosthetic infective endocarditis caused by another germ); Prognosis; OR; TTE; CI; Prothèse du cœur gauche; methicillin-resistant Staphylococcus aureus; transthoracic echocardiography; Pronostic; odds ratio; TOE; SAPIE; MRSA; Infective endocarditis; Sepsis; Staphylococcus aureus prosthetic infective endocarditis; confidence interval; NSAPIE; Endocardite infectieuse; IE; transoesophageal echocardiography; Staphylococcus aureus
• ISSN: 1875-2136; 1875-2128
• DOI: 10.1016/j.acvd.2016.02.010

Summary Background Staphylococcus aureus prosthetic valve endocarditis (SAPIE) is a serious disease. Aims Our objective was to study the clinical, echocardiographic and prognostic characteristics of left-sided SAPIE, and to compare these characteristics with those of left-sided non- S .  aureus prosthetic infective endocarditis (NSAPIE) (i.e. left-sided prosthetic infective endocarditis caused by another germ). Methods This was a retrospective analysis of 35 cases of SAPIE among 247 cases of left-sided prosthetic valve endocarditis hospitalized at two university hospitals (Amiens and Marseille, France). Results SAPIE accounted for 14.1% of the cases of left-sided prosthetic valve endocarditis. SAPIE complications included heart failure (in 42.8% of cases), acute renal failure (in 51.4%), sepsis (in 51.4%), neurological events (in 31.4%), systemic embolic event (in 34.2%) and abscess (in 60.0%). In-hospital mortality occurred in 48.5% of SAPIE cases compared with 16% of NSAPIE cases. A comparison of the SAPIE and NSAPIE groups showed a significant difference in terms of 4-year survival (31.8 ± 7.3% vs 60.1 ± 4.1%; P = 0.001). Severe sepsis was the only prognostic factor associated with in-hospital mortality (odds ratio 5.7; P = 0.03) and long-term mortality (odds ratio 3.7; P = 0.01) in cases of SAPIE. Sepsis-induced multiple organ dysfunction syndrome was the main cause of in-hospital mortality (70.5%). Conclusions SAPIE is a very serious disease, with elevated in-hospital mortality resulting from sepsis-induced multiple organ dysfunction syndrome. Emergency surgery is recommended in these cases, when possible, before the occurrence of complications, especially severe sepsis.