Observational studyBMC infectious diseases2025
Staphylococcal early-onset prosthetic valve endocarditis: a condition bound for surgery.
Observational study in BMC infectious diseases, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundEarly-onset prosthetic valve endocarditis (EO-PVE) is linked to poor in-hospital outcomes. Staphylococcus spp. poses a significant concern due to its higher mortality rates compared to other major infectious agents.
objectivesProvide a more detailed, comprehensive evaluation of the clinical characteristics and in-hospital mortality predictors related to staphylococcal EO-PVE.
methodsThis observational, retrospective, single-center study was conducted at a tertiary hospital in Brazil from 1997 to 2019, spanning a 22-year period. A total of 105 consecutive cases of left-heart staphylococcal EO-PVE were analyzed.
resultsThere was a predominance of coagulase-negative staphylococci prosthetic valve endocarditis (CoNS PVE) over Staphylococcus aureus prosthetic valve endocarditis (SAPVE) (76% and 24%, respectively). Prosthetic valve replacement for EO-PVE treatment was performed in 73% of cases. In-hospital mortality was 49%, with SAPVE associated with a higher in-hospital mortality than CoNS PVE (80% versus 43%, p < 0.001). In-hospital mortality predictors identified by univariate analysis included older age (p < 0.001), aortic prosthetic endocarditis (p < 0.001), peri-annular abscess (p = 0.002), SAPVE (p < 0.001), NYHA functional class III/IV (p = 0.02), previous combined myocardial revascularization with valve replacement surgery (p = 0.02), left ventricular dysfunction (p < 0.001), leukocytosis (p = 0.02), and higher C-reactive protein levels (p = 0.006). In a multivariate analysis, SAPVE was identified as an independent risk factor for in-hospital mortality (odds ratio [OR] 10.2; p = 0.006), whereas prosthetic valve replacement was associated with improved in-hospital survival (OR 0.2; p = 0.04).
conclusionStaphylococcal EO-PVE is associated with increased in-hospital mortality, particularly in SAPVE cases. In this study, all non-operated SAPVE patients died primarily due to fulminant septic shock. Prosthetic valve replacement was significantly linked to in-hospital survival, and only 5.7% of the study population survived without cardiac surgical intervention. CLINICAL TRIAL NUMBER: Not applicable.
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