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KMID : 0882420090760030329
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Korean Journal of Medicine
2009 Volume.76 No. 3 p.329 ~ p.337
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Clinical characteristics of infective endocarditis caused by Staphylococcus aureus: A 12-year experience in a tertiary-care hospital
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Kim Eun-Seok
Joo Eun-Jeong
Ha Young-Eun
Wi Yu-Mi
Cheong Hae-Suk
Lee Jin-Seo
Kang Cheol-In
Chung Doo-Ryeon
Park Seung-Woo
Park Pyo-Won
Lee Nam-Yong
Peck Kyong-Ran
Song Jae-Hoon
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Abstract
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Background/Aims: The risk factors and clinical outcome of infective endocarditis (IE) have changed over the past few decades. Recently, the incidence of Staphylococcus aureus IE (SAIE) has increased. We investigated the clinical and microbiological characteristics and clinical outcomes of SAIE.
Methods: All patient cases that were diagnosed as IE according to the modified Duke criteria in Samsung Medical Center during the period of January 1995 to December 2006 were reviewed retrospectively. The clinical and microbiological characteristics of patients with SAIE were compared to those of non-SAIE patients with IE.
Results: We enrolled 304 patients with IE. Of these, 240 cases were IE culture-positive, including 73 cases of SAIE. The mean age of patients with SAIE was 48.15±19.87 years, with male patients accounting for 71.2% of our study group. Congenital heart disease (8.2%) was less common among SAIE patients. Hospital-acquired IE was significantly more common in SAIE than in non-SAIE cohorts (p<0.05). Surgical treatment was performed in 33 cases (45.2%). Valvular regurgitation with heart failure was the most frequent cause of surgery (39.3%). Twenty-three cases exhibited complications, including extra cardiac embolization (16.4%) and heart failure (5.6%). Fever persisting for a period longer than seven days was more common among those in the SAIE group. Twelve patients (16.4%) died and four patients (5.4%) were discharged without hope of improvement. The in-hospital mortality rate was higher among SAIE patients (17.3%) compared to that among non-SAIE patients (11%), although this comparison was not statistically distinct (p>0.05). Methicillin resistance and non-surgical treatment were significant risk factors for in-hospital mortality.
Conclusions: SAIE is more strongly associated with systemic embolization, persistent fever, and longer hospital stays compared to non-SAIE. Further studies are warranted to evaluate adequate treatment and to improve the outcome of patients with SAIE.
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KEYWORD
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Infective endocarditis, Methicillin-resistance, Outcome, Staphylococcus aureus
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