A STUDY OF 47 BACTEREMIC STAPHYLOCOCCUS-AUREUS ENDOCARDITIS CASES - 23 WITH NATIVE VALVES TREATED SURGICALLY AND 24 WITH PROSTHETIC VALVES

A retrospective review of medical records from the Staphylococcus Labo ratory, Copenhagen, 1982-1991, was carried out at the Department of Cl inical Microbiology, Statens Serum Institut, 1994-1995, to investigate the clinical features and outcome of two subgroups of bacteremic Stap hylococcus aureus endocarditis cases in non-drug addicts: patients wit h prosthetic valve endocarditis (PVE) and patients with native valve e ndocarditis treated surgically. Twenty-four cases of PVE were included . Six cases were early (within 60 days of valve implantation) and 18 w ere late. The overall in-hospital mortality was 42%. Surgical treatmen t resulted in a non-significantly lower mortality as compared with med ical treatment alone (0% vs 50%, p = 0.19). Medical treatment of aorti c and mitral valve endocarditis resulted in similar mortality rates (4 4% and 50%, respectively). Twenty-three cases of native valve infectiv e endocarditis had the valve replaced surgically. The in-hospital mort ality was 22%, which was significantly lower as compared with medical therapy (69%, p < 0.0001). The treatment changed significantly during the study period: 6 of 112 patients (5%) were treated surgically in th e first half of the period (1982-1986) compared to 17 of 124 patients (14%) in the second half (1987-1991, p = 0.049). Severe congestive hea rt failure was the main indication for cardiac surgery in 21 patients. In conclusion, a shift towards a more aggressive surgical approach ha s taken place in the 10-year period. This development should be streng thened in the future as surgical intervention may improve survival in patients with infective endocarditis caused by S. aureus whether the i nfected valve is prosthetic or native.