Virulence of Staphylococcus Infection in Surgically Treated Patients With Endocarditis

Abstract

Objective: Infective endocarditis (IE) caused by Staphylococcus species (spp.) is believed to be associated with higher morbidity and mortality rates. We hypothesize that Staphylococcus spp. are more virulent compared with other commonly causative bacteria of IE with regard to shortterm and long-term mortality. Background: It remains unclear if patients suffering from IE due to Staphylococcus spp. should be referred for surgical treatment earlier than other IE patients to avoid septic embolism and to optimize perioperative outcomes. Materials and Methods: The database of the CAMPAIGN registry, comprising 4917 consecutive patients undergoing heart valve surgery, was retrospectively analyzed. Patients were divided into 2 groups with regard to the identified microorganisms: Staphylococcus group and the non-Staphylococcus group. The non-Staphylococcus group was subdivided for further analyses: Streptococcus group, Enterococcus group, and all other bacteria groups. Results: The respective mortality rates at 30 days (18.7% vs 11.8%; P < 0.001), 1 year (24.7% vs 17.7%; P < 0.001), and 5 years (32.2% vs 24.5%; P < 0.001) were significantly higher in Staphylococcus patients (n = 1260) compared with the non-Staphylococcus group (n = 1787).Multivariate regression identified left ventricular ejection fraction <30% (P < 0.001), chronic obstructive pulmonary disease (P = 0.045), renal insufficiency (P = 0.002), Staphylococcus spp. (P = 0.032), and Streptococcus spp. (P = 0.013) as independent risk factors for 30-day mortality. Independent risk factors for 1-year mortality were identified as: age (P < 0.001), female sex (P = 0.018), diabetes (P = 0.018), preoperative stroke (P = 0.039), chronic obstructive pulmonary disease (P = 0.001), preoperative dialysis (P < 0.001), and valve vegetations (P = 0.004). Conclusions: Staphylococcus endocarditis is associated with an almost twice as high 30-day mortality and significantly inferior long-term outcome compared with IE by other commonly causative bacteria. Patients with Staphylococcus infection are more often female and critically ill, with > 50% of these patients suffering from clinically relevant septic embolism. Early diagnosis and referral to a specialized center for surgical treatment are strongly recommended to reduce the incidence of preoperative deterioration and stroke due to septic embolism.

Effect of intraoperative haemoadsorption therapy on cardiac surgery for active infective endocarditis with confirmedStaphylococcus aureusbacteraemia

“…IE caused by S. aureus is associated with high rates of postoperative sepsis and increased mortality [ 16 , 17 ]. A recent multicentre analysis evaluating 4917 patients showed almost double 30-day mortality in Staphylococcus caused IE patients [ 8 ]. Within the present study we could confirm that mortality is still high in such a high-risk cohort presenting with IE.…”

Impact of Aortic Root Abscess on Surgical Outcomes of Infective Endocarditis

“…and LVEF < 30% correlated with 1-year mortality. Both advanced age and infection with Staphylococcus aureus are evidenced predictors of worse survival in surgically treated IE patients [14][15][16]. Higher ejection fraction was found to be associated with better survival after surgery for PVE [17].…”

New Insights into Mortality-Related Risk Factors in Infective Endocarditis: Results from the Brandenburg State Endocarditis Register

“…These results are also confirmed by other studies. 26 This points toward the necessity of strict hygienic standards in medical facilities such as nursing homes, outpatient care, dialysis centers, and clearly also in the hospitals.…”