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. 2015 Mar 1;60(5):741-9.
doi: 10.1093/cid/ciu871. Epub 2014 Nov 10.

Impact of early valve surgery on outcome of Staphylococcus aureus prosthetic valve infective endocarditis: analysis in the International Collaboration of Endocarditis-Prospective Cohort Study

Catherine Chirouze  1 , François Alla  2 , Vance G Fowler Jr  3 , Daniel J Sexton  3 , G Ralph Corey  3 , Vivian H Chu  3 , Andrew Wang  3 , Marie-Line Erpelding  4 , Emanuele Durante-Mangoni  5 , Nuria Fernández-Hidalgo  6 , Efthymia Giannitsioti  7 , Margaret M Hannan  8 , Tatjana Lejko-Zupanc  9 , José M Miró  10 , Patricia Muñoz  11 , David R Murdoch  12 , Pierre Tattevin  13 , Christophe Tribouilloy  14 , Bruno Hoen  15 ; ICE Prospective Investigators
Collaborators, Affiliations

Impact of early valve surgery on outcome of Staphylococcus aureus prosthetic valve infective endocarditis: analysis in the International Collaboration of Endocarditis-Prospective Cohort Study

Catherine Chirouze et al. Clin Infect Dis. .

Abstract

Background: The impact of early valve surgery (EVS) on the outcome of Staphylococcus aureus (SA) prosthetic valve infective endocarditis (PVIE) is unresolved. The objective of this study was to evaluate the association between EVS, performed within the first 60 days of hospitalization, and outcome of SA PVIE within the International Collaboration on Endocarditis-Prospective Cohort Study.

Methods: Participants were enrolled between June 2000 and December 2006. Cox proportional hazards modeling that included surgery as a time-dependent covariate and propensity adjustment for likelihood to receive cardiac surgery was used to evaluate the impact of EVS and 1-year all-cause mortality on patients with definite left-sided S. aureus PVIE and no history of injection drug use.

Results: EVS was performed in 74 of the 168 (44.3%) patients. One-year mortality was significantly higher among patients with S. aureus PVIE than in patients with non-S. aureus PVIE (48.2% vs 32.9%; P = .003). Staphylococcus aureus PVIE patients who underwent EVS had a significantly lower 1-year mortality rate (33.8% vs 59.1%; P = .001). In multivariate, propensity-adjusted models, EVS was not associated with 1-year mortality (risk ratio, 0.67 [95% confidence interval, .39-1.15]; P = .15).

Conclusions: In this prospective, multinational cohort of patients with S. aureus PVIE, EVS was not associated with reduced 1-year mortality. The decision to pursue EVS should be individualized for each patient, based upon infection-specific characteristics rather than solely upon the microbiology of the infection causing PVIE.

Keywords: 1-year mortality; endocarditis; prosthetic valve; surgery.

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Figure 1.
Figure 1.
Sample acquisition. Abbreviations: ICE-PCS, International Collaboration on Endocarditis–Prospective Cohort Study; IDUs, intravenous drug users; IE, infective endocarditis.
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