Chu Vivian H, Woods Christopher W, Miro Jose M, Hoen Bruno, Cabell Christopher H, Pappas Paul A, Federspiel Jerome, Athan Eugene, Stryjewski Martin E, Nacinovich Francisco, Marco Francesc, Levine Donald P, Elliott Tom S, Fortes Claudio Q, Tornos Pilar, Gordon David L, Utili Riccardo, Delahaye Francois, Corey G Ralph, Fowler Vance G
Duke University Medical Center, Durham, North Carolina 27710, USA.
Clin Infect Dis. 2008 Jan 15;46(2):232-42. doi: 10.1086/524666.
Coagulase-negative staphylococci (CoNS) are an infrequent cause of native valve endocarditis (NVE), and our understanding of NVE caused by CoNS is incomplete.
The International Collaboration on Endocarditis-Prospective Cohort Study includes patients with endocarditis from 61 centers in 28 countries. Patients with definite cases of NVE caused by CoNS who were enrolled during the period June 2000-August 2006 were compared with patients with definite cases of NVE caused by Staphylococcus aureus and patients with NVE caused by viridans group streptococci. Multivariable logistic regression was used to determine factors associated with death in patients with NVE caused by CoNS.
Of 1635 patients with definite NVE and no history of injection drug use, 128 (7.8%) had NVE due to CoNS. Health care-associated infection occurred in 63 patients (49%) with NVE caused by CoNS. Comorbidities, long-term intravascular catheter use, and history of recent invasive procedures were similar among patients with NVE caused by CoNS and among patients with NVE caused by S. aureus. Surgical treatment for endocarditis occurred more frequently in patients with NVE due to CoNS (76 patients [60%]) than in patients with NVE due to S. aureus (150 [33%]; P=.01) or in patients with NVE due to viridans group streptococci (149 [44%]; P=.01). Despite the high rate of surgical procedures among patients with NVE due to CoNS, the mortality rates among patients with NVE due to CoNS and among patients with NVE due to S. aureus were similar (32 patients [25%] and 124 patients [27%], respectively; P=.44); the mortality rate among patients with NVE due to CoNS was higher than that among patients with NVE due to viridans group streptococci (24 [7.0%]; P=.01). Persistent bacteremia (odds ratio, 2.65; 95% confidence interval, 1.08-6.51), congestive heart failure (odds ratio, 3.35; 95% confidence interval, 1.57-7.12), and chronic illness (odds ratio, 2.86; 95% confidence interval, 1.34-6.06) were independently associated with death in patients with NVE due to CoNS (c index, 0.73).
CoNS have emerged as an important cause of NVE in both community and health care settings. Despite high rates of surgical therapy, NVE caused by CoNS is associated with poor outcomes.
凝固酶阴性葡萄球菌（CoNS）是天然瓣膜心内膜炎（NVE）的少见病因，我们对CoNS所致NVE的认识尚不完整。
国际心内膜炎协作组前瞻性队列研究纳入了来自28个国家61个中心的心内膜炎患者。将2000年6月至2006年8月期间纳入的由CoNS引起的确诊NVE患者与由金黄色葡萄球菌引起的确诊NVE患者以及由草绿色链球菌引起的NVE患者进行比较。采用多变量逻辑回归分析确定CoNS所致NVE患者死亡的相关因素。
在1635例确诊NVE且无注射吸毒史的患者中，128例（7.8%）因CoNS导致NVE。63例（49%）由CoNS引起NVE的患者发生了医疗保健相关感染。CoNS所致NVE患者、金黄色葡萄球菌所致NVE患者的合并症、长期血管内导管使用情况及近期侵入性操作史相似。CoNS所致NVE患者接受心内膜炎手术治疗的频率高于金黄色葡萄球菌所致NVE患者（76例[60%]比150例[33%]；P=0.01）或草绿色链球菌所致NVE患者（149例[44%]；P=0.01）。尽管CoNS所致NVE患者手术率较高，但CoNS所致NVE患者与金黄色葡萄球菌所致NVE患者的死亡率相似（分别为32例[25%]和124例[27%]；P=0.44）；CoNS所致NVE患者的死亡率高于草绿色链球菌所致NVE患者（24例[7.0%]；P=0.01）。持续性菌血症（比值比，2.65；95%置信区间为1.08 - 6.51）、充血性心力衰竭（比值比3.35；95%置信区间为1.57 - 7.12）和慢性病（比值比2.86；95%置信区间为1.34 - 6.06）与CoNS所致NVE患者死亡独立相关（c指数为0.73）。
CoNS已成为社区和医疗保健环境中NVE的重要病因。尽管手术治疗率高，但CoNS所致NVE的预后较差。
