Staphylococcus aureus endocarditis at a community teaching hospital, 1980 to 1991. An analysis of 106 cases.

BACKGROUND

The clinical diagnosis of infective endocarditis due to Staphylococcus aureus can be difficult, and many patients with this disease are only diagnosed post mortem. There are few published reports of large series of patients with S aureus endocarditis and none from a community hospital. I reviewed the clinical and laboratory findings of a large number of patients with S aureus endocarditis in a community hospital.

METHODS

I reviewed medical records identified through consultation records, International Classification of Diseases, Ninth Edition codes, and autopsy records of patients who fulfilled the criteria for the diagnosis of S aureus endocarditis during 1980 to 1991.

RESULTS

During the 12-year period, there were 106 cases, for a prevalence of 0.34 per 1000 admissions. Ninety-three (87.7%) of these patients were seen by me. The patients' ages ranged from 12 to 83 years (median, 61 years). Eighteen cases were nosocomial (15 were associated with intravascular catheters). Twenty-one patients were injecting drug users. Severe back pain was the chief complaint in nine patients. Twenty-seven patients had no heart murmur at the time of diagnosis. The overall mortality was 25.5%.

CONCLUSIONS

Age 60 years or older, female gender, community-acquired infection, absence of heart murmur, presence of congestive heart failure, or central nervous system involvement was associated with higher mortality. Tricuspid valve endocarditis alone was associated with lower mortality.