Coagulase-negative Staphylococcal Prosthetic Valve Endocarditis: A Contemporary Update based on the International Collaboration on Endocarditis – Prospective Cohort Study
- Vivian Chu ( )
- Published Online First 24 October 2008
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.
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.