RETROSPECTIVE EVALUATION OF THERAPIES FOR STAPHYLOCOCCUS-AUREUS ENDOCARDITIS

We retrospectively evaluated antiinfective therapy for methicillin-sen sitive (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA) e ndocarditis in 54 patients who had 57 treatment courses for the diseas e. Three treatments were assessed: 27 nafcillin-treated courses of MSS A endocarditis, 18 vancomycin-treated courses of MSSA endocarditis, an d 11 vancomycin-treated courses of MRSA endocarditis. At baseline, pat ients with MSSA treated with vancomycin had more chronic conditions (p <0.01), a lower frequency of intravenous drug use (p<0.01), a lower he matocrit concentration (p<0.05), and a higher serum creatinine concent ration (p<0.05) than the nafcillin group. Vancomycin-treated patients had a higher complication rate during therapy (p<0.05) and a longer du ration in an intensive care unit (p<0.01) than the nafcillin group. Th e trend was for a higher complete response rate in the nafcillin group (74% vs 50%, p=0.12), but no difference in mortality (22% vs 28%, p=0 .73). Patients with MRSA infection treated with vancomycin had higher mortality than those with MSSA who received that drug (55% vs 28%, p=0 .24). Patients with vancomycin-treated MSSA endocarditis may have a po orer outcome than those who receive nafcillin, but this may be influen ced by different or more severe clinical features.