Native valve endocarditis caused by coagulase-negative staphylococci had a 25% mortality rate, similar to S. aureus (27%, P=.44) but higher than viridans group streptococci (7.0%, P=.01).
Cohort (n=1,635)
Yes
Does native valve endocarditis caused by coagulase-negative staphylococci result in different mortality and surgical rates compared to S. aureus or viridans group streptococci?
Coagulase-negative staphylococci have emerged as an important cause of native valve endocarditis, carrying a high mortality rate (25%) comparable to S. aureus despite frequent surgical intervention.
Absolute Event Rate: 25% vs 27%
p-value: p=.44
BACKGROUND: Coagulase-negative staphylococci (CoNS) are an infrequent cause of native valve endocarditis (NVE), and our understanding of NVE caused by CoNS is incomplete. METHOD: The International Collaboration on Endocarditis-Prospective Cohort Study includes patients with endocarditis from 61 centers in 28 countries. Patients with definite cases of NVE caused by CoNS who were enrolled during the period June 2000-August 2006 were compared with patients with definite cases of NVE caused by Staphylococcus aureus and patients with NVE caused by viridans group streptococci. Multivariable logistic regression was used to determine factors associated with death in patients with NVE caused by CoNS. RESULTS: Of 1635 patients with definite NVE and no history of injection drug use, 128 (7.8%) had NVE due to CoNS. Health care-associated infection occurred in 63 patients (49%) with NVE caused by CoNS. Comorbidities, long-term intravascular catheter use, and history of recent invasive procedures were similar among patients with NVE caused by CoNS and among patients with NVE caused by S. aureus. Surgical treatment for endocarditis occurred more frequently in patients with NVE due to CoNS (76 patients 60%) than in patients with NVE due to S. aureus (150 33%; P=.01) or in patients with NVE due to viridans group streptococci (149 44%; P=.01). Despite the high rate of surgical procedures among patients with NVE due to CoNS, the mortality rates among patients with NVE due to CoNS and among patients with NVE due to S. aureus were similar (32 patients 25% and 124 patients 27%, respectively; P=.44); the mortality rate among patients with NVE due to CoNS was higher than that among patients with NVE due to viridans group streptococci (24 7.0%; P=.01). Persistent bacteremia (odds ratio, 2.65; 95% confidence interval, 1.08-6.51), congestive heart failure (odds ratio, 3.35; 95% confidence interval, 1.57-7.12), and chronic illness (odds ratio, 2.86; 95% confidence interval, 1.34-6.06) were independently associated with death in patients with NVE due to CoNS (c index, 0.73). CONCLUSIONS: CoNS have emerged as an important cause of NVE in both community and health care settings. Despite high rates of surgical therapy, NVE caused by CoNS is associated with poor outcomes.
Chu et al. (2007) conducted a cohort in Native valve endocarditis (n=1,635). Coagulase-negative staphylococci (CoNS) infection vs. Staphylococcus aureus and viridans group streptococci infection was evaluated on Mortality (p=.44). Native valve endocarditis caused by coagulase-negative staphylococci had a 25% mortality rate, similar to S. aureus (27%, P=.44) but higher than viridans group streptococci (7.0%, P=.01).