Staphylococcus aureus native valve infective endocarditis:: Report of 566 episodes from the International Collaboration on Endocarditis Merged Database
Staphylococcus aureus native valve infective endocarditis:: Report of 566 episodes from the International Collaboration on Endocarditis Merged Database
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DOI：
10.1086/431979
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发表时间：
2005-08-15
影响因子：
11.8
通讯作者：
Fowler, VG
中科院分区：
文献类型：
--
作者：
Miro, JM;Anguera, I;Fowler, VG
背景金黄色葡萄球菌自体瓣膜感染性心内膜炎（SA-NVIE）尚未完全了解。本研究的目的是描述一个大型的国际性SA-NVIE患者队列的特征。国际心内膜炎协作合并数据库（ICE-MD）是来自5个国家的7个现有电子数据库的组合，包含2212例确诊感染性心内膜炎（IE）病例的数据。在自体瓣膜IE患者中，566例（34%）患者因S。金黄色葡萄球菌以外的病原体所致IE 1074例。金黄色葡萄球菌（非SA-NVIE）。S.金黄色葡萄球菌IE更容易死亡（20% vs. 12%;），发生栓塞事件（60% vs. 31%;），或发生中枢神经系统P < .001 P < .001事件（20%对13%;）和不太可能接受手术（26%对39%;）的患者P <0.001 P <0.001非SA-NVIE。影响死亡年龄预后的多因素分析（比值比[OR]，1.4; 95%置信区间[CI]，1.1-1.7），环周脓肿（OR，2.4; 95% CI，1.1-5.6），心力衰竭（OR，3.9; 95% CI，2.3-6.7），且未接受手术治疗（OR，2.3; 95%CI，1.3-4.2）作为变量与SA-NVIE患者的死亡率独立相关。通过多变量分析校正患者、病原体和治疗特异性特征后，发现地理区域也与SA-NVIE患者的死亡率相关（P <0.001）。S.金黄色葡萄球菌是IE的一个重要且常见的原因。SA-NVIE的预后比非SA-NVIE差。几个临床参数与SA-NVIE患者的死亡率独立相关。SA-NVIE的临床特征和结局因地理区域而异，尽管SA-NVIE结局的区域性差异的原因尚不清楚，可能是多因素的。目前正在对IE患者进行一项大型、前瞻性、多国队列研究，以进一步研究这些观察结果。
Background. Staphylococcus aureus native valve infective endocarditis (SA-NVIE) is not completely understood. The objective of this investigation was to describe the characteristics of a large, international cohort of patients with SA-NVIE.Methods. The International Collaboration on Endocarditis Merged Database (ICE-MD) is a combination of 7 existing electronic databases from 5 countries that contains data on 2212 cases of definite infective endocarditis (IE).Results. Of patients with native valve IE, 566 patients (34%) had IE due to S. aureus, and 1074 patients had IE due to pathogens other than S. aureus (non-SA-NVIE). Patients with S. aureus IE were more likely to die (20% vs. 12%;), to experience an embolic event (60% vs. 31%;), or to have a central nervous system P < .001 P < .001 event (20% vs. 13%;) and were less likely to undergo surgery (26% vs. 39%;) than were patients P < .001 P < .001 with non-SA-NVIE. Multivariate analysis of prognostic factors of mortality identified age (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.1-1.7), periannular abscess (OR, 2.4; 95% CI, 1.1-5.6), heart failure (OR, 3.9; 95% CI, 2.3-6.7), and absence of surgical therapy (OR, 2.3; 95% CI, 1.3-4.2) as variables that were independently associated with mortality in patients with SA-NVIE. After adjusting for patient-, pathogen-, and treatment-specific characteristics by multivariate analysis, geographical region was also found to be associated with mortality in patients with SA-NVIE (P < .001).Conclusions. S. aureus is an important and common cause of IE. The outcome of SA-NVIE is worse than that of non-SA-NVIE. Several clinical parameters are independently associated with mortality for patients with SA-NVIE. The clinical characteristics and outcome of SA-NVIE vary significantly by geographic region, although the reasons for such regional variations in outcomes of SA-NVIE are unknown and are probably multifactorial. A large, prospective, multinational cohort study of patients with IE is now under way to further investigate these observations.