Clinical and prognostic differences between methicillin-resistant and methicillin-susceptible Staphylococcus aureus infective endocarditis

BMC Infectious Diseases

Carmen Hidalgo-Tenorio¹  Francisco Javier Martínez-Marcos²  José M. Reguera³  Antonio Plata-Ciezar³  Juan Gálvez⁴  Luis Eduardo López-Cortés⁴  Maria Victoria García⁵  Guillermo Ojeda⁵  Rafael Luque⁶  Jose Antonio Lepe⁶  Arístides de Alarcón⁶  José Manuel Lomas⁷  David Vinuesa⁸  Javier De La Torre-Lima⁹  Mariam Noureddine⁹ 

[1] Department of Infectious Diseases, Hospital Universitario Virgen de las Nieves;Infectious Disease Service, Hospital Juan Ramón Jiménez;Infectious Disease Service, Hospital Regional Universitario Carlos Haya;Infectious Disease Service, Hospital Universitario Virgen de la Macarena;Infectious Disease Service, Hospital Universitario Virgen de la Victoria;Infectious Disease Service, Hospital Universitario Virgen del Rocío;Infectious Disease Service, Oxford University Hospitals NHS Foundation Trust;Infectious Disease Unit, Hospital Universitario San Cecilio;Internal Medicine Service, Hospital Costa del Sol;

关键词: Endocarditis;    Staphylococcus aureus;    Vancomycin;    Methicillin resistance;   

DOI  :  10.1186/s12879-020-4895-1

来源: DOAJ

【 摘 要 】

Abstract Background S. aureus (SA) infective endocarditis (IE) has a very high mortality, attributed to the age and comorbidities of patients, inadequate or delayed antibiotic treatment, and methicillin resistance, among other causes. The main study objective was to analyze epidemiological and clinical differences between IE by methicillin-resistant versus methicillin-susceptible SA (MRSA vs. MSSA) and to examine prognostic factors for SA endocarditis, including methicillin resistance and vancomycin minimum inhibitory concentration (MIC) values > 1 μg/mL to MRSA. Methods Patients with SA endocarditis were consecutively and prospectively recruited from the Andalusia endocarditis cohort between 1984 and January 2017. Results We studied 437 patients with SA endocarditis, which was MRSA in 13.5% of cases. A greater likelihood of history of COPD (OR 3.19; 95% CI 1.41–7.23), invasive procedures, or recognized infection focus in the 3 months before IE onset (OR 2.9; 95% CI 1.14–7.65) and of diagnostic delay (OR 3.94; 95% CI 1.64–9.5) was observed in patients with MRSA versus MSSA endocarditis. The one-year mortality rate due to SA endocarditis was 44.3% and associated with decade of endocarditis onset (1985–1999) (OR 8.391; 95% CI (2.82–24.9); 2000–2009 (OR 6.4; 95% CI 2.92–14.06); active neoplasm (OR 6.63; 95% CI 1.7–25.5) and sepsis (OR 2.28; 95% CI 1.053–4.9). Methicillin resistance was not associated with higher IE-related mortality (49.7 vs. 43.1%; p = 0.32). Conclusion MRSA IE is associated with COPD, previous invasive procedure or recognized infection focus, and nosocomial or healthcare-related origin. Methicillin resistance does not appear to be a decisive prognostic factor for SA IE.

【 授权许可】

Unknown