Staphylococcal early-onset prosthetic valve endocarditis: a condition bound for surgery

Abstract Background: Early-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. Objectives: Provide a more detailed, comprehensive evaluation of the clinical characteristics and in-hospital mortality predictors related to staphylococcal EO-PVE. Methods: This observational, retrospective, single-center study was conducted at a tertiary hospital in Brazil over a 22-year period from 1997 to 2019. A total of 105 consecutive cases of left-heart staphylococcal EO-PVE were analyzed. Results: There 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 found to be an independent risk factor for in-hospital mortality (odds ratio [OR] 10.2; p=0.006), while prosthetic valve replacement was associated with improved in-hospital survival (OR 0.2; p=0.04). Conclusion: Staphylococcal 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.