Predictors of Death and Impact of Surgery in Staphylococcus aureus Infective Endocarditis

Rémadi, Jean Paul; Habib, Gilbert; Nadji, Georges; Brahim, Amel; Thuny, Franck; Casalta, Jean Paul; Peltier, Marcel; Tribouilloy, Christophe

doi:10.1016/j.athoracsur.2006.09.093

Cited by 97 publications

(65 citation statements)

References 42 publications

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“…While methicillin-resistant S. aureus has become a concern, MSSA still accounts for the majority of cases of IE caused by S. aureus in many recent series (4,8,9,19,20). Also, other studies have shown that CI of a ␤-lactam reduces pharmacy preparation time, reduces nursing administration time, and maximizes antimicrobial pharmacodynamics (7).…”

Section: Discussionmentioning

confidence: 99%

Continuous versus Intermittent Infusion of Oxacillin for Treatment of Infective Endocarditis Caused by Methicillin-Susceptible Staphylococcus aureus

Hughes

Frei

Maxwell

et al. 2009

Antimicrob Agents Chemother

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Infective endocarditis (IE) is the fourth leading cause of life-threatening infection in the UnitedStates and imposes significant morbidity and mortality. The American Heart Association guidelines for the diagnosis and treatment of IE do not address continuous-infusion (CI) oxacillin. This retrospective study compares outcomes between CI oxacillin and intermittent-infusion (II) oxacillin in the treatment of IE caused by methicillinsusceptible Staphylococcus aureus (MSSA). A total of 709 medical records were reviewed for inpatients with definitive IE treated between 1 January 2000 and 31 December 2007. Continuous data were analyzed by Student's t test or the Wilcoxon rank sum test. The chi-square test or Fisher's exact test was used to compare nominal data. A multivariate logistic model was constructed. One hundred seven patients met eligibility criteria for inclusion into the study. Seventy-eight patients received CI oxacillin, whereas 28 received II oxacillin. CI and II groups were similar with respect to 30-day mortality (8% versus 10%, P ‫؍‬ 0.7) and length of stay (20 versus 25 days, P ‫؍‬ 0.4) but differed in 30-day microbiological cure (94% versus 79%, P ‫؍‬ 0.03). Sixty-three patients received synergistic gentamicin, whereas 44 did not. The gentamicin and no-gentamicin groups were similar with respect to 30-day mortality (11% versus 4%, P ‫؍‬ 0.2) and 30-day microbiological cure (90% versus 89%, P ‫؍‬ 0.8); however, times to defervescence (4 versus 2 days, P ‫؍‬ 0.02) were significantly different. CI oxacillin is an effective alternative to II oxacillin for the treatment of IE caused by MSSA and may improve microbiological cure. This convenient and pharmacodynamically optimized dosing regimen for oxacillin deserves consideration for patients with IE caused by MSSA.Infective endocarditis (IE) is the fourth leading cause of life-threatening infection in the United States and imposes significant morbidity and mortality (2). Staphylococcus aureus now exceeds viridans group streptococci as the leading cause of IE in much of the developed world, including the United States, and IE caused by S. aureus has been shown to be an independent predictor of increased mortality (4, 9). Overall, mortality from IE remains as high as 40% in some series, and complications of IE, such as congestive heart failure, extracardiac infections, and thromboembolic events, occur more often with IE caused by S. aureus than with IE caused by other pathogens (1, 9, 11, 15-17). The American Heart Association (AHA) has recently issued evidence-based guidelines for the diagnosis and treatment of patients with IE, which recommend intermittent-infusion (II) oxacillin at 12 g daily divided every 4 to 6 h for up to 6 weeks for treatment of IE caused by methicillin-susceptible S. aureus (MSSA) (1). Although data for continuous-infusion (CI) oxacillin are lacking, oxacillin exhibits time-dependent bactericidal activity, has a short postantibiotic effect against MSSA, and has been promoted as an alternative to II oxacillin, which maximizes bacteri...

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Section: Discussionmentioning

confidence: 99%

Continuous versus Intermittent Infusion of Oxacillin for Treatment of Infective Endocarditis Caused by Methicillin-Susceptible Staphylococcus aureus

Hughes

Frei

Maxwell

et al. 2009

Antimicrob Agents Chemother

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“…This situation is more common with aggressive organisms, including S aureus, 21 and when vegetations are bulky and resistant to antibiotic penetration. Current guidelines indicate that surgery should be considered if fever or positive blood cultures persist after 7 days of appropriate therapy.…”

Section: Persistent Sepsismentioning

confidence: 99%

“…41,42 Although no correction was made for underlying comorbidity, similar results were reported in 2 more recent Scandinavian studies, 26,43 in which the best results were obtained with early intervention within 1 week of presentation. Early valve surgery in patients with congestive heart failure is associated with a substantial reduction in mortality compared with medical therapy alone, 5,15,21,22,44 and this scenario is now the most common and clearest indication for surgery, being present in 72% of patients who underwent early intervention in a recent European series. 19 Congestive heart failure is usually the result of valvular regurgitation, which may develop acutely as a result of perforation of a native valve or bioprosthetic valve leaflet or rupture of infected mitral chordae.…”

Section: Congestive Heart Failure Due To Valvular Regurgitationmentioning

confidence: 99%

“…S aureus IE is characterized by an aggressive clinical course associated with severe valvular damage, large vegetations, embolic complications, and overall poor prognosis. 18,21,71 Early surgery should be considered in all cases affecting a prosthetic valve and most cases affecting a left-sided native valve if an immediate response is not obtained with appropriate antibiotic therapy. …”

Section: Difficult Organismsmentioning

confidence: 99%

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Surgery for Infective Endocarditis

2010

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“…In-hospital mortality was defined as death occurring during the index hospitalization [14]. Causes of death were divided into major cerebral events as defined previously versus others, and were based on clinical findings at the time of death or autopsy findings.…”

Section: Methodsmentioning

confidence: 99%

Major Cerebral Events in <i>Staphylococcus Aureus</i> Infective Endocarditis: Is Anticoagulant Therapy Safe?

et al. 2009

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Objectives: To study the impact of anticoagulation on major cerebral events in patients with left-sided Staphylococcus aureus infective endocarditis (IE). Methods: A prospective cohort study; the use of anticoagulation and the relation to major cerebral events was evaluated separately at onset of admission and during hospitalization. Results: Overall, 70 out of 175 patients (40%; 95% CI: 33–47%) experienced major cerebral events during the course of the disease, cerebral ischaemic stroke occured in 59 patients (34%; 95% CI: 27–41%), cerebral infection in 23 patients (14%; 95% CI: 9–19%), and cerebral haemorrhage in 5 patients (3%; 95% CI: 0.5–6%). Patients receiving anticoagulation were less likely to have experienced a major cerebral event at the time of admission (15%) compared with those without anticoagulation (37%, p = 0.009; adjusted OR: 0.27; 95% CI: 0.075–0.96; p = 0.04). In-hospital mortality was 23% (95% CI: 17–29%), and there was no significant difference between those with or without anticoagulation. Conclusions: We found no increased risk of cerebral haemorrhage in S. aureus IE patients receiving anticoagulation. Anticoagulation was associated with a reduced risk of cerebral events before initiation of antibiotics. Data support the continuance of anticoagulation in S. aureus IE patients when indicated.

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Predictors of Death and Impact of Surgery in Staphylococcus aureus Infective Endocarditis

Cited by 97 publications

References 42 publications

Continuous versus Intermittent Infusion of Oxacillin for Treatment of Infective Endocarditis Caused by Methicillin-Susceptible Staphylococcus aureus

Continuous versus Intermittent Infusion of Oxacillin for Treatment of Infective Endocarditis Caused by Methicillin-Susceptible Staphylococcus aureus

Surgery for Infective Endocarditis

Major Cerebral Events in <i>Staphylococcus Aureus</i> Infective Endocarditis: Is Anticoagulant Therapy Safe?

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