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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© 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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