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.
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.
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Competing interests: JMM has received honorariums for speaking or participating in advisory boards or research funding from Abbott, Boehringer-Ingelheim, Bristol-Myers Squibb (BMS), Chiron, Cubist, Novartis, GlaxoSmithKline (GSK), Gilead Sciences, Oxford Immunotec, Pfizer, Roche and Theravance. MES has received honorariums from Astellas and is a consultant for Theravance. GRC is a consultant for Theravance, Cubist, and Cerexa, and is on the advisory board for Pfizer, Inhibitex, Merck, Vicuron and Johnson & Johnson. VGF has served as a consultant for Astellas, Biosynexus, Inhibitex, Merck, Johnson & Johnson and Theravance.
Funding: This study was supported by a grant from the American Heart Association (0675027N) to VHC. This study was also supported by the National Institutes of Health (VGF); Ministerio de Sanidad y Consumo, Instituto de Salud Carlos III, Spanish Network for the Research in Infectious Diseases (REIPI RD06/0008)” (JMM and BA) and FIS 05/0170 (JMM), from the “Fundación Privada Máximo Soriano Jiménez” for the grant supporting the Hospital Clínic Endocarditis database (JMM); research grant from the “Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)” and the “Conselleria de Salut de la Generalitat de Catalunya, Barcelona (Spain)” (JMM).
Ethics approval: Ethics committee approval obtained.
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