Impact of early valve surgery on outcome of Staphylococcus aureus prosthetic valve infective endocarditis - Analysis in the International Collaboration of Endocarditis - Prospective Cohort Study.
Clin Infect Dis. 2014 Nov 10;
Authors: Chirouze C, Alla F, Fowler VG, Sexton DJ, Corey GR, Chu V, Wang A, Erpelding ML, Durante-Mangoni E, Fernández-Hidalgo N, Giannitsioti E, Hannan MM, Lejko-Zupanc T, Miró JM, Muñoz P, Murdoch DR, Tattevin P, Tribouilloy C, Hoen B, on behalf of the ICE Prospective Investigators
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 one-year all-cause mortality on patients with definite left-sided SA PVIE and no history of injection drug use.
RESULTS: EVS was performed in74 (44.3%) of the 168 patients. One-year mortality was significantly higher among patients with SA PVIE than in patients with non-SA PVIE (48.2% vs. 32.9%, p=0.003). SA PVIE patients who underwent EVS had a significantly lower one-year mortality rate (33.8% vs. 59.1%, p=0.001).In multivariate, propensity-adjusted models, EVS was not associated with one-year mortality (RR 0.67, 95% CI 0.39 - 1.15, p=0.15).
CONCLUSIONS: In this prospective, multinational cohort of patients with SA PVIE ,: EVS was not associated with reduced one-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.
PMID: 25389255 [PubMed - as supplied by publisher]