Journal Article

Coagulase-negative staphylococcal prosthetic valve endocarditis—a contemporary update based on the International Collaboration on Endocarditis: prospective cohort study

Tornos, P, Chu, V H, Oyonarte, M, Morris, A J, Jones, P, Braun, S, Cabell, C H, Sexton, D J, Pappas, P A, Muñoz, P, Anguera, I, Almirante, B, Habib, G, Hoen, B, Selton-Suty, C, Miro, J M, Fowler, V G, Francis, J, Stryjewski, M E, Corey, G R, Commerford, P

2009

Overview

Objective:To describe the contemporary features of coagulase-negative staphylococcal (CoNS) prosthetic valve endocarditis (PVE).Design:Observational study of prospectively collected data from a multinational cohort of patients with infective endocarditis. Patients with CoNS PVE were compared to patients with Staphylococcus aureus and viridans streptococcal (VGS) PVE.Setting:The International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS) is a contemporary cohort of patients with infective endocarditis from 61 centres in 28 countries.Patients:Adult patients in the ICE-PCS with definite PVE and no history of injecting drug use from June 2000 to August 2005 were included.Interventions:None.Main outcome measures:Heart failure, intracardiac abscess, death.Results:CoNS caused 16% (n = 86) of 537 cases of definite non-injecting drug use-associated PVE. Nearly one-half (n = 33/69, 48%) of patients with CoNS PVE presented between 60 days and 365 days of valve implantation. The rate of intracardiac abscess was significantly higher in patients with CoNS PVE (38%) than in patients with either S aureus (23%, p = 0.03) or VGS (20%, p = 0.05) PVE. The rate of abscess was particularly high in early (50%) and intermediate (52%) CoNS PVE. In-hospital mortality was 24% for CoNS PVE, 36% for S aureus PVE (p = 0.09) and 9.1% for VGS PVE (p = 0.08). Meticillin resistance was present in 68% of CoNS strains.Conclusions:Nearly one-half of CoNS PVE cases occur between 60 days and 365 days of prosthetic valve implantation. CoNS PVE is associated with a high rate of meticillin resistance and significant valvular complications.

• Publisher: BMJ Publishing Group Ltd and British Cardiovascular Society,BMJ Publishing Group,BMJ Publishing Group LTD
• Subject: Aged / Antibiotics / Bacterial / Bacterial diseases / Bacteriology / Bias / Biological and medical sciences / Bioprosthesis / Cardiology. Vascular system / Cardiovascular disease / Chronic illnesses / Coagulase / Collaboration / Cross Infection / Cross Infection - drug therapy / Cross Infection - microbiology / Cross Infection - mortality / Drug Resistance / Drug Resistance, Microbial / drug therapy / Endocardial and cardiac valvular diseases / Endocarditis / Endocarditis, Bacterial / Endocarditis, Bacterial - drug therapy / Endocarditis, Bacterial - microbiology / Endocarditis, Bacterial - mortality / Female / Heart / Heart failure / Heart Valve Prosthesis / Hospital Mortality / Human bacterial diseases / Humans / Infectious diseases / Infectious Medicine / Infektionsmedicin / Life Sciences / Male / Medical sciences / Microbial / microbiology / Microbiology and Parasitology / Middle Aged / Mortality / Nonparametric / Nosocomial infections / Orthopedic surgery / Postoperative Complications / Postoperative Complications - drug therapy / Postoperative Complications - microbiology / Postoperative Complications - mortality / Prospective Studies / Prostheses / Prosthesis-Related Infections / Prosthesis-Related Infections - drug therapy / Prosthesis-Related Infections - microbiology / Prosthesis-Related Infections - mortality / Staphylococcal Infections / Staphylococcal Infections - drug therapy / Staphylococcal Infections - mortality / Staphylococcal infections, streptococcal infections, pneumococcal infections / Staphylococcus aureus / Statistics / Statistics, Nonparametric / Studies / Surgery / Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases / Time Factors