STAPHYLOCOCCUS-AUREUS PROSTHETIC VALVE ENDOCARDITIS - OPTIMAL MANAGEMENT AND RISK-FACTORS FOR DEATH

The mortality rate associated with Staphylococcus aureus prosthetic va lve endocarditis (PVE) remains high. To identify clinical events; asso ciated with an increased risk of death among patients with S. aureus P VE and to evaluate the role of valve replacement surgery in reducing m ortality, we conducted a retrospective cohort study of patients who me t strict criteria for definite S. aureus PVE. The primary endpoint for the study was survival at 3 months from the date of diagnosis. S. aur eus PVE was diagnosed in 33 patients. Of these, 14 (42%) died within 9 0 days of the diagnosis. Cardiac complications were detected in 22 (67 %), and central nervous system (CNS) complications were detected in 11 (33%). A stepwise logistic regression multivariate model demonstrated that cardiac complications, but not CNS complications, were associate d with increased mortality and that performing valve replacement surge ry during antibiotic therapy was associated with decreased mortality. These associations were confirmed by using a Cox proportional hazards model with time-dependent covariates to control for survival bias. Per forming valve replacement surgery during antimicrobial therapy will re duce the mortality among patients with S. aureus PVE, even those witho ut evidence of cardiac complications.