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Coagulase-negative Staphylococcal Prosthetic Valve Endocarditis: A Contemporary Update based on the International Collaboration on Endocarditis – Prospective Cohort Study
  1. Vivian Chu (chu00009{at}mc.duke.edu)
  1. Duke University Medical Center, United States
    1. Jose M Miro
    1. Hospital Clinic Institut d’Investigacions Biomèdiques August Pi i Sunyer – Univer, Spain
      1. Bruno Hoen
      1. Hôpital Saint-Jacques, France
        1. Christopher H. Cabell
        1. Duke University Medical Center, United States
          1. Paul A Pappas
          1. Duke University Medical Center, United States
            1. Phillip Jones
            1. The University of New South Wales, Australia
              1. Martin E Stryjewski
              1. Centro de Educación Médica e Investigaciones Clínicas, Argentina
                1. Ignasi Anguera
                1. Hospitál de Bellvitge, Spain
                  1. Sandra Braun
                  1. Hosp. Clínico Pont. Universidad Católica de Chile, Chile
                    1. Patricia Munoz
                    1. Hospital General Universitario Gregorio Marañón, Spain
                      1. Patrick Commerford
                      1. University of Cape Town and Groote Schuur Hospital, South Africa
                        1. Pilar Tornos
                        1. Hospital Universitari Vall d’Hebron, Spain
                          1. Johnson Francis
                          1. Medical College Calicut, India
                            1. Miguel Oyonarte
                            1. Hospital Clinico Universidad de Chile, Chile
                              1. Christine Selton-Suty
                              1. CHU Nancy-Brabois, France
                                1. Arthur J Morris
                                1. Auckland City Hospital, New Zealand
                                  1. Gilbert Habib
                                  1. Faculté de Médecine de Marseille, France
                                    1. Benito Almirante
                                    1. Hospital Universitari Vall d’Hebron, Spain
                                      1. Daniel J Sexton
                                      1. Duke University Medical Center, United States
                                        1. Gordon R Corey
                                        1. Duke University Medical Center, United States
                                          1. Vance G Fowler, Jr
                                          1. Duke University Medical Center, United States

                                            Abstract

                                            Objective: Describe the contemporary features of coagulase-negative staphylococcal (CoNS) prosthetic valve endocarditis (PVE).

                                            Design: Observational study of prospectively collected data from a multi-national cohort of patients with infective endocarditis. Patients with CoNS PVE were compared to patients with S. 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 centers in 28 countries.

                                            Patients: Adult patients in the ICE-PCS with definite PVE and no history of injection drug use from 6/00–8/05 were included.

                                            Interventions: None.

                                            Main Outcome Measures: Heart failure, intracardiac abscess, death.

                                            Results: CoNS caused 16% (n=86) of 537 cases of definite non-injection drug use-associated PVE. Nearly one-half (n=33/69, 48%) of patients with CoNS PVE presented between 60 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). Methicillin resistance was present in 68% of CoNS strains.

                                            Conclusions: Nearly one-half of CoNS PVE cases occur between 60 and 365 days of prosthetic valve implantation. CoNS PVE is associated with a high rate of methicillin resistance and significant valvular complications.

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