Coagulase-negative staphylococcal prosthetic valve endocarditis—a contemporary update based on the International Collaboration on Endocarditis: prospective cohort study
- V H Chu1,2,
- J M Miro3,
- B Hoen4,
- C H Cabell1,2,
- P A Pappas2,
- P Jones5,
- M E Stryjewski2,6,
- I Anguera7,
- S Braun8,
- P Muñoz9,
- P Commerford10,
- P Tornos11,
- J Francis12,
- M Oyonarte13,
- C Selton-Suty14,
- A J Morris15,
- G Habib16,
- B Almirante11,
- D J Sexton1,
- G R Corey1,2,
- V G Fowler Jr1,2,
- for the International Collaboration on Endocarditis-Prospective Cohort Study Group
- 1Duke University Medical Center, Durham, North Carolina, USA
- 2Duke Clinical Research Institute, Durham, North Carolina, USA
- 3Hospital Clinic Institut d’Investigacions Biomèdiques August Pi i Sunyer-University of Barcelona, Barcelona, Spain
- 4Hôpital Saint-Jacques, Besançon, France
- 5The University of New South Wales, Sydney, Australia
- 6Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires, Argentina
- 7Hospitál de Bellvitge, Barcelona, Spain
- 8Hospital Clínico Pontificia Universidad Católica de Chile, Santiago, Chile
- 9Hospital General Universitario Gregorio Marañón, Madrid, Spain
- 10University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- 11Hospital Universitari Vall d’Hebron, Barcelona, Spain
- 12Medical College Calicut, Kerala, India
- 13Hospital Clinico Universidad de Chile, Santiago, Chile
- 14CHU Nancy-Brabois, Nancy, France
- 15Auckland City Hospital, Auckland, New Zealand
- 16Faculté de Médecine de Marseille, Marseille, France
- Dr Vivian H Chu, Duke University Medical Center, Box 3850, Durham, NC 27710, USA; chu00009{at}mc.duke.edu
- Accepted 3 September 2008
- Published Online First 24 October 2008
Abstract
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.
Interventions: None.
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.
Footnotes
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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.
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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).
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Ethics approval: Ethics committee approval obtained.
