Catherine Chirouze1, François Alla2, Vance G Fowler3, Daniel J Sexton3, G Ralph Corey3, Vivian H Chu3, Andrew Wang3, Marie-Line Erpelding4, Emanuele Durante-Mangoni5, Nuria Fernández-Hidalgo6, Efthymia Giannitsioti7, Margaret M Hannan8, Tatjana Lejko-Zupanc9, José M Miró10, Patricia Muñoz11, David R Murdoch12, Pierre Tattevin13, Christophe Tribouilloy14, Bruno Hoen15. 1. UMR CNRS 6249 Chrono-Environnement, Université de Franche-Comté Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Régional Universitaire, Besançon. 2. Université de Lorraine, Université Paris Descartes, Apemac, EA4360 INSERM, CIC-EC, CIE6 CHU Nancy, Pôle S2R, Epidémiologie et Evaluation Cliniques, Nancy, France. 3. Department of Medicine, Duke University Medical Center, Durham, North Carolina. 4. INSERM, CIC-EC, CIE6 CHU Nancy, Pôle S2R, Epidémiologie et Evaluation Cliniques, Nancy, France. 5. Department of Cardiothoracic Sciences, University of Naples S.U.N., Monaldi Hospital, Italy. 6. Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain. 7. Fourth Department of Internal Medicine, Attikon University General Hospital, Athens, Greece. 8. Department of Microbiology, Mater Misericordiae University Hospital, Dublin, Ireland. 9. Department of Infectious Diseases, Medical Centre Ljubljana, Slovenia. 10. Hospital Clinic-IDIBAPS, University of Barcelona. 11. Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain. 12. Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand. 13. Maladies Infectieuses et Réanimation Médicale, Pontchaillou University Hospital, Rennes. 14. Départment de Cardiologie, Hôpital Universitaire Sud, Amiens. 15. UMR CNRS 6249 Chrono-Environnement, Université de Franche-Comté Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Régional Universitaire, Besançon Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud, EA 4537, Pointe-à-Pitre, Guadeloupe Service de Maladies Infectieuses et Tropicales, CIC 1424, Centre Hospitalier Universitaire, Pointe-à-Pitre, France.
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.
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.
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