Department of Infectious Diseases, Hospital Universitario Virgen de las Nieves, Av. de las Fuerzas Armadas n° 2, 18014, Granada, Spain.
Infectious Disease Service, Hospital Universitario Virgen de la Macarena, Sevilla, Spain.
BMC Infect Dis. 2020 Feb 21;20(1):160. doi: 10.1186/s12879-020-4895-1.
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.
Patients with SA endocarditis were consecutively and prospectively recruited from the Andalusia endocarditis cohort between 1984 and January 2017.
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).
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.
金黄色葡萄球菌（SA）感染性心内膜炎（IE）的死亡率非常高，这归因于患者的年龄和合并症、抗生素治疗不足或延迟、耐甲氧西林以及其他原因。主要研究目的是分析耐甲氧西林金黄色葡萄球菌（MRSA）与甲氧西林敏感金黄色葡萄球菌（MSSA）IE 之间的流行病学和临床差异，并检查金黄色葡萄球菌心内膜炎的预后因素，包括耐甲氧西林和万古霉素最小抑菌浓度（MIC）值>1μg/ml 与 MRSA 相关。
我们从 1984 年至 2017 年 1 月连续前瞻性地从安达卢西亚心内膜炎队列中招募了患有 SA 心内膜炎的患者。
我们研究了 437 例 SA 心内膜炎患者，其中 13.5%的病例为 MRSA。与 MSSA 心内膜炎相比，MRSA 心内膜炎患者更有可能有 COPD 病史（OR 3.19；95%可信区间 1.41-7.23）、侵入性操作或在 IE 发病前 3 个月内发现感染灶（OR 2.9；95%可信区间 1.14-7.65）和诊断延迟（OR 3.94；95%可信区间 1.64-9.5）。SA 心内膜炎的一年死亡率为 44.3%，与心内膜炎发病的十年有关（1985-1999 年）（OR 8.391；95%可信区间 2.82-24.9）；（2000-2009 年）（OR 6.4；95%可信区间 2.92-14.06）；活动性肿瘤（OR 6.63；95%可信区间 1.7-25.5）和败血症（OR 2.28；95%可信区间 1.053-4.9）。耐甲氧西林与 IE 相关死亡率增加无关（49.7%比 43.1%；p=0.32）。
MRSA IE 与 COPD、先前的侵入性操作或已识别的感染灶以及医院或医疗保健相关的来源有关。耐甲氧西林似乎不是 SA IE 的决定性预后因素。
