OBJECTIVE
To investigate the risk factors for Staphylococcus aureus infective endocarditis (SAIE)
and 6-month mortality in patients with S aureus bacteremia (SAB).
PATIENTS AND METHODS
This study consisted of patients who were diagnosed as having nosocomial or community-acquired
SAB or SAIE between June 1, 2000, and December 31, 2005. Clinical characteristics
of patients with SAB were compared with those of patients with SAIE, and predictors
of mortality in patients with SAB were analyzed.
RESULTS
The median age of the 132 randomly selected patients with SAB and the 66 patients
with SAIE was 66 and 68 years, respectively. Univariable analysis showed that unknown
origin of SAB, a valvular prosthesis, a pacemaker, persistent fever, and persistent
bacteremia were significantly associated with SAIE. In multivariable analysis, unknown
origin of SAB (odds ratio [OR], 4.2; 95% confidence interval [CI], 1.9-9.3; P=.001), a valvular prosthesis (OR, 9.2; 95% CI, 3.2-26.2; P<.001), persistent fever (OR, 3.1; 95% CI, 1.0-9.0; P=.04), and persistent bacteremia (OR, 6.8; 95% CI, 2.3-20.2; P=.001) were independently associated with SAIE. Six-month mortality was 8% in patients
with SAB vs 35% in patients with SAIE (OR, 6.5; 95% CI, 2.9-14.8; P<.001). In univariable analysis, methicillin-resistant S aureus (OR, 7.2; 95% CI, 1.7-29.4; P=.005) was significantly associated with 6-month mortality in patients with SAB.
CONCLUSION
Unknown origin of SAB, a valvular prosthesis, persistent fever, and persistent bacteremia
were independently associated with SAIE in patients with SAB. In univariable analysis,
methicillin-resistant S aureus was associated with 6-month mortality in patients with SAB. S aureus infective endocarditis
had a significantly higher mortality than SAB. The optimal management of SAB and SAIE
deserves further study.
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REFERENCES
- Infective endocarditis in adults.N Engl J Med. 2001; 345: 1318-1330
- Risk factors for metastatic infection in patients with Staphylococcus aureus bacteremia with and without endocarditis.Eur J Intern Med. 2003; 14: 227-231
- A prospective multicenter study of Staphylococcus aureus bacteremia: incidence of endocarditis, risk factors for mortality, and clinical impact of methicillin resistance.Medicine (Baltimore). 2003; 82: 322-332
- Risk of endocarditis among patients with prosthetic valves and Staphylococcus aureus bacteremia.Am J Med. 2005; 118: 225-229
- Clinical identifiers of complicated Staphylococcus aureus bacteremia.Arch Intern Med. 2003; 163: 2066-2072
- Risk factors for nosocomial infective endocarditis in patients with methicillin-resistant Staphylococcus aureus bacteremia.Infect Control Hosp Epidemiol. 2005; 26: 654-657
- Course and outcome of Staphylococcus aureus bacteraemia: a retrospective analysis of 308 episodes in a Swiss tertiary-care centre.Clin Microbiol Infect. 2006; 12: 345-352
- Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis.Clin Infect Dis. 2000 Apr; 30 (Epub 2000 Apr 3.): 633-638
- ESC Committee for Practice Guidelines (CPG). Guidelines on prevention, diagnosis and treatment of infective endocarditis executive summary.Eur Heart J. 2004; 25: 267-276
- Infectious Disease Society of America, American College of Critical Care Medicine, Society for Healthcare Epidemiology of America. Guidelines for the management of intravascular catheter-related infections.Clin Infect Dis. 2001 May 1; 32 (Epub 2001 Apr 3.): 1249-1272
- A comparison of hospital and community-acquired infective endocarditis.Am J Cardiol. 1992; 70: 1449-1452
- Hospital-acquired infective endocarditis.Arch Intern Med. 1988; 148: 1601-1603
- Outcome and attributable mortality in critically Ill patients with bacteremia involving methicillin-susceptible and methicillin-resistant Staphylococcus aureus.Arch Intern Med. 2002; 162: 2229-2235
- Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis.Clin Infect Dis. 2003 Jan 1; 36 (Epub 2002 Dec 13.): 53-59
- Is methicillin-resistant Staphylococcus aureus more virulent than methicillin-susceptible S. aureus? a comparative cohort study of British patients with nosocomial infection and bacteremia.Clin Infect Dis. 2003 Dec 1; 37 (Epub 2003 Nov 6.): 1453-1460
- Impact of methicillin resistance on outcome of Staphylococcus aureus ventilator-associated pneumonia.Am J Respir Crit Care Med. 2004 Oct 1; 170 (Epub 2004 Jul 8.): 786-792
- The impact of methicillin resistance on the outcome of poststernotomy mediastinitis due to Staphylococcus aureus.Clin Infect Dis. 2004 Mar 15; 38 (Epub 2004 Feb 27.): 822-829
- Impact of the use of aminoglycosides in combination antibiotic therapy on septic shock and mortality due to Staphylococcus aureus bacteremia.Eur J Intern Med. 2006; 17: 276-280
- Daptomycin versus standard therapy for bacteremia and endocarditis caused by Staphylococcus aureus.N Engl J Med. 2006; 355: 653-665
- Phase II, randomized, double-blind, multicenter study comparing the safety and pharmacokinetics of tefibazumab to placebo for treatment of Staphylococcus aureus bacteremia.Antimicrob Agents Chemother. 2006; 50: 2751-2755
Article Info
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© 2007 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
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- Staphylococcus aureus Bacteremia and Infective Endocarditis: Old Questions, New Answers?Mayo Clinic ProceedingsVol. 82Issue 10
- PreviewIn a recent population-based surveillance study in Olmsted County, MN, between 2003 and 2005, Staphylococcus aureus was the most common cause of nosocomial bacteremia and the second most common cause of community-acquired bacteremia.1 S aureus bacteremia (SAB) can be complicated by infective endocarditis (IE), a syndrome associated with high morbidity and mortality rates.2
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