Surgery for infective endocarditis: Staphylococcus aureus Versus Other Microbiological Etiologies

Objectives Surgery for infective endocarditis (IE) can/may improve outcome, but also carries significant risk. Staphylococcus aureus infective endocarditis (SA-IE) is increasing in prevalence and carries in-hospital mortality rates between 30 – 40%. However, robust data regarding surgical outcomes stratified by causative microorganism remain limited. We compared in-hospital and one-year morbidity and mortality among surgically treated patients with SA-IE versus non-SA-IE. Methods Using the NatIonal Danish endocarditis stUdieS registry, we identified all patients who underwent valvular surgery for left-sided IE between 2016 and 2021. Patients were categorized into two groups: SA-IE and non-SA-IE. All-cause mortality was assessed using crude estimates, multivariable logistic regression, and Cox regression adjusted for relevant confounders. Results We identified 662 patients who underwent surgery, 160 (24.2%) had SA-IE (median age 63.7 years; 73.1% male), and 502 (75.8%) had non-SA-IE (median age 67.5; 79.1% male). SA-IE patients more frequently presented with sepsis (52.5% vs. 17.3%) and embolic events (24.4% vs. 17.1%). SA-IE patients had longer hospital stays (47 days vs. 44 days) and were more often intubated in the ICU for >7 days (13.1% vs. 6.8%). Crude in-hospital mortality (16.5% vs. 11.4%) and one-year mortality (22.0% vs. 15.8%) were higher among SA-IE patients. After adjusting for confounders, SA-IE was associated with higher in-hospital mortality (OR 1.77 [95% CI 1.03 – 3.04]) and one-year mortality (HR 1.68 [95% CI 1.10 – 2.57]). Conclusion Despite younger age and similar baseline comorbidities, patients who underwent surgery for SA-IE were associated with higher post-operative morbidity and increased in-hospital and one-year mortality, compared to patients with non-SA-IE.