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Valvular heart disease
Coagulase-negative staphylococcal prosthetic valve endocarditis—a contemporary update based on the International Collaboration on Endocarditis: prospective cohort study
  1. V H Chu1,2,
  2. J M Miro3,
  3. B Hoen4,
  4. C H Cabell1,2,
  5. P A Pappas2,
  6. P Jones5,
  7. M E Stryjewski2,6,
  8. I Anguera7,
  9. S Braun8,
  10. P Muñoz9,
  11. P Commerford10,
  12. P Tornos11,
  13. J Francis12,
  14. M Oyonarte13,
  15. C Selton-Suty14,
  16. A J Morris15,
  17. G Habib16,
  18. B Almirante11,
  19. D J Sexton1,
  20. G R Corey1,2,
  21. V G Fowler Jr1,2,
  22. for the International Collaboration on Endocarditis-Prospective Cohort Study Group
  1. 1
    Duke University Medical Center, Durham, North Carolina, USA
  2. 2
    Duke Clinical Research Institute, Durham, North Carolina, USA
  3. 3
    Hospital Clinic Institut d’Investigacions Biomèdiques August Pi i Sunyer-University of Barcelona, Barcelona, Spain
  4. 4
    Hôpital Saint-Jacques, Besançon, France
  5. 5
    The University of New South Wales, Sydney, Australia
  6. 6
    Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires, Argentina
  7. 7
    Hospitál de Bellvitge, Barcelona, Spain
  8. 8
    Hospital Clínico Pontificia Universidad Católica de Chile, Santiago, Chile
  9. 9
    Hospital General Universitario Gregorio Marañón, Madrid, Spain
  10. 10
    University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
  11. 11
    Hospital Universitari Vall d’Hebron, Barcelona, Spain
  12. 12
    Medical College Calicut, Kerala, India
  13. 13
    Hospital Clinico Universidad de Chile, Santiago, Chile
  14. 14
    CHU Nancy-Brabois, Nancy, France
  15. 15
    Auckland City Hospital, Auckland, New Zealand
  16. 16
    Faculté de Médecine de Marseille, Marseille, France
  1. Dr Vivian H Chu, Duke University Medical Center, Box 3850, Durham, NC 27710, USA; chu00009{at}


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.

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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.