Staphylococcus aureus Endocarditis: A Consequence of Medical Progress

• Published in: JAMA : the journal of the American Medical Association Vol. 293; no. 24; pp. 3012 - 3021
• Main Authors: Fowler, Vance G, Miro, Jose M, Hoen, Bruno, Cabell, Christopher H, Abrutyn, Elias, Rubinstein, Ethan, Corey, G. Ralph, Spelman, Denis, Bradley, Suzanne F, Barsic, Bruno, Pappas, Paul A, Anstrom, Kevin J, Wray, Dannah, Fortes, Claudio Q, Anguera, Ignasi, Athan, Eugene, Jones, Philip, van der Meer, Jan T. M, Elliott, Tom S. J, Levine, Donald P, Bayer, Arnold S, ICE Investigators, for the
• Format: Journal Article
• Language: English
• Published: Chicago, IL American Medical Association 22-06-2005
• Subjects: Biological and medical sciences; Biomedical research; Cardiology. Vascular system; Cross Infection - epidemiology; Cross Infection - microbiology; Cross Infection - mortality; Drug resistance; Endocardial and cardiac valvular diseases; Endocarditis, Bacterial - epidemiology; Endocarditis, Bacterial - microbiology; Endocarditis, Bacterial - mortality; General aspects; Global Health; Health risk assessment; Heart; Hospital Mortality; Humans; Infectious diseases; Medical sciences; Methicillin Resistance; Pathogens; Prospective Studies; Staphylococcal Infections - epidemiology; Staphylococcal Infections - microbiology; Staphylococcal Infections - mortality; Staphylococcus aureus - drug effects; Infection; Medicine; Heart disease; Endocardial disease; Endocarditis; Bacteriosis; Cardiovascular disease; Bacteria; Micrococcales; Micrococcaceae; Staphylococcal infection; Staphylococcus aureus
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.293.24.3012

CONTEXT The global significance of infective endocarditis (IE) caused by Staphylococcus aureus is unknown. OBJECTIVES To document the international emergence of health care–associated S aureus IE and methicillin-resistant S aureus (MRSA) IE and to evaluate regional variation in patients with S aureus IE. DESIGN, SETTING, AND PARTICIPANTS Prospective observational cohort study set in 39 medical centers in
16 countries. Participants were a population of 1779 patients with definite
IE as defined by Duke criteria who were enrolled in the International Collaboration
on Endocarditis-Prospective Cohort Study from June 2000 to December 2003. MAIN OUTCOME MEASURE In-hospital mortality. RESULTS S aureus was the most common pathogen among
the 1779 cases of definite IE in the International Collaboration on Endocarditis
Prospective-Cohort Study (558 patients, 31.4%). Health care−associated
infection was the most common form of S aureus IE
(218 patients, 39.1%), accounting for 25.9% (Australia/New Zealand) to 54.2%
(Brazil) of cases. Most patients with health care−associated S aureus IE (131 patients, 60.1%) acquired the infection outside of
the hospital. MRSA IE was more common in the United States (37.2%) and Brazil
(37.5%) than in Europe/Middle East (23.7%) and Australia/New Zealand (15.5%, P<.001). Persistent bacteremia was independently associated
with MRSA IE (odds ratio, 6.2; 95% confidence interval, 2.9-13.2). Patients
in the United States were most likely to be hemodialysis dependent, to have
diabetes, to have a presumed intravascular device source, to receive vancomycin,
to be infected with MRSA, and to have persistent bacteremia (P<.001 for all comparisons). CONCLUSIONS S aureus is the leading cause of IE in many
regions of the world. Characteristics of patients with S aureus IE vary significantly by region. Further studies are required
to determine the causes of regional variation.