Incidence and Surgical Outcomes of Staphylococcus endocarditis: A Contemporary Analysis from the CAMPAIGN Registry

Background: Infective endocarditis (IE) caused by Staphylococcus species has been noted to increase and is believed to be associated with higher morbidity and mortality rates. We hypothesize that Staphylococcus species are more virulent compared with other commonly causative bacteria of IE.

Method: The database of the Clinical Multicenter Project for Analysis of Infective Endocarditis in Germany (CAMPAIGN), comprising 4917 consecutive patients undergoing heart valve surgery, was retrospectively analyzed. The patients were divided into two main groups with regard to the identified microorganisms: Staphylococcus group (1) and Non-staphylococcus group (2). To allow for further subgroup analyses patients from group 2 were also divided into three subgroups: Streptococcus group, Enterococcus group and all other bacteria. Parts of the study have been published elsewhere.

Results: The respective mortality rates at 30 days (18.7 vs. 11.8%; p < 0.001), 1 (24.7 vs. 17.7%; p < 0.001) and 5 years (32.2 vs. 24.5%; p < 0.001) were significantly higher in Staphylococcus patients (n = 1,260) compared with the non-Staphylococcus group (n = 1787). Multivariate regression identified LVEF <30% (p < 0.001), COPD (p = 0.045), preoperative renal insufficiency (p = 0.002), as well as Staphylococcus (p = 0.032), and Streptococcus spp. (p = 0.013) as independent risk factors for 30-day mortality. Additionally, the following parameters were identified as risk factors for 1-year mortality: age (p < 0.001), female gender (p = 0.018), diabetes (p = 0.018), preoperative stroke (p = 0.039), COPD (p = 0.001), preoperative dialysis (p < 0.001), and the presence of valve vegetations (p = 0.004).

Conclusion: Staphylococcus endocarditis is associated with an almost twice as high 30-day mortality and significantly inferior long-term outcome compared with IE by other commonly causative bacteria. In comparison, patients with Staphylococcus infection are more likely to be female and critically ill, with more than 50% of these patients suffering from clinically relevant septic embolism. Early diagnosis and treatment with referral to a specialized center is strongly recommended to reduce the incidence of preoperative deterioration and stroke due to embolism.

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Artikel online veröffentlicht:
03. Februar 2022