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Risk Factors for Infective Endocarditis and Outcome of Patients With Staphylococcus aureus Bacteremia

      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.
      CI (confidence interval), IE (infective endocarditis), IQR (interquartile range), MRSA (methicillin-resistant Staphylococcus aureus), OR (odds ratio), SAB (S aureus bacteremia), SAIE (S aureus infective endocarditis), TEE (transesophageal echocardiography)
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      REFERENCES

        • Mylonakis E
        • Calderwood SB
        Infective endocarditis in adults.
        N Engl J Med. 2001; 345: 1318-1330
        • Lesens O
        • Hansmann Y
        • Storck D
        • Christmann D
        Risk factors for metastatic infection in patients with Staphylococcus aureus bacteremia with and without endocarditis.
        Eur J Intern Med. 2003; 14: 227-231
        • Chang FY
        • MacDonald BB
        • Peacock Jr, JE
        • et al.
        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
        • El-Ahdab F
        • Benjamin Jr, DK
        • Wang A
        • et al.
        Risk of endocarditis among patients with prosthetic valves and Staphylococcus aureus bacteremia.
        Am J Med. 2005; 118: 225-229
        • Fowler Jr, VG
        • Olsen MK
        • Corey GR
        • et al.
        Clinical identifiers of complicated Staphylococcus aureus bacteremia.
        Arch Intern Med. 2003; 163: 2066-2072
        • Hsu RB
        Risk factors for nosocomial infective endocarditis in patients with methicillin-resistant Staphylococcus aureus bacteremia.
        Infect Control Hosp Epidemiol. 2005; 26: 654-657
        • Kaech C
        • Elzi L
        • Sendi P
        • et al.
        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
        • Li JS
        • Sexton DJ
        • Mick N
        • et al.
        Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis.
        Clin Infect Dis. 2000 Apr; 30 (Epub 2000 Apr 3.): 633-638
        • Horstkotte D
        • Follath F
        • Gutschik E
        • et al.
        ESC Committee for Practice Guidelines (CPG). Guidelines on prevention, diagnosis and treatment of infective endocarditis executive summary.
        Eur Heart J. 2004; 25: 267-276
        • Mermel LA
        • Farr BM
        • Sherertz RJ
        • et al.
        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
        • Chen SC
        • Dwyer DE
        • Sorrell TC
        A comparison of hospital and community-acquired infective endocarditis.
        Am J Cardiol. 1992; 70: 1449-1452
        • Terpenning MS
        • Buggy BP
        • Kauffman CA
        Hospital-acquired infective endocarditis.
        Arch Intern Med. 1988; 148: 1601-1603
        • Blot SI
        • Vandewoude KH
        • Hoste EA
        • Colardyn FA
        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
        • Cosgrove SE
        • Sakoulas G
        • Perencevich EN
        • Schwaber MJ
        • Karchmer AW
        • Carmeli Y
        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
        • Melzer M
        • Eykyn SJ
        • Gransden WR
        • Chinn S
        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
        • Combes A
        • Luyt CE
        • Fagon JY
        • PNEUMA Trial Group
        • et al.
        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
        • Combes A
        • Trouillet JL
        • Joly-Guillou ML
        • Chastre J
        • Gibert C
        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
        • Lesens O
        • Brannigan E
        • Bergin C
        • Christmann D
        • Hansmann Y
        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
        • Fowler Jr, VG
        • Boucher HW
        • Corey GR
        • S. aureus Endocarditis and Bacteremia Study Group
        • et al.
        Daptomycin versus standard therapy for bacteremia and endocarditis caused by Staphylococcus aureus.
        N Engl J Med. 2006; 355: 653-665
        • Weems Jr, JJ
        • Steinberg JP
        • Filler S
        • et al.
        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

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