John M D, Hibberd P L, Karchmer A W, Sleeper L A, Calderwood S B
Medical Services, Massachusetts General Hospital, Boston 02114, USA.
Clin Infect Dis. 1998 Jun;26(6):1302-9. doi: 10.1086/516378.
The mortality rate associated with Staphylococcus aureus prosthetic valve endocarditis (PVE) remains high. To identify clinical events associated with an increased risk of death among patients with S. aureus PVE and to evaluate the role of valve replacement surgery in reducing mortality, we conducted a retrospective cohort study of patients who met strict criteria for definite S. aureus PVE. The primary endpoint for the study was survival at 3 months from the date of diagnosis. S. aureus PVE was diagnosed in 33 patients. Of these, 14 (42%) died within 90 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 associated with increased mortality and that performing valve replacement surgery 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. Performing valve replacement surgery during antimicrobial therapy will reduce the mortality among patients with S. aureus PVE, even those without evidence of cardiac complications.
金黄色葡萄球菌人工瓣膜心内膜炎（PVE）的死亡率仍然很高。为了确定与金黄色葡萄球菌PVE患者死亡风险增加相关的临床事件，并评估瓣膜置换手术在降低死亡率中的作用，我们对符合确诊金黄色葡萄球菌PVE严格标准的患者进行了一项回顾性队列研究。该研究的主要终点是从诊断日期起3个月的生存率。33例患者被诊断为金黄色葡萄球菌PVE。其中，14例（42%）在诊断后90天内死亡。22例（67%）检测到心脏并发症，11例（33%）检测到中枢神经系统（CNS）并发症。逐步逻辑回归多变量模型表明，心脏并发症而非CNS并发症与死亡率增加相关，且在抗生素治疗期间进行瓣膜置换手术与死亡率降低相关。通过使用具有时间依赖性协变量的Cox比例风险模型来控制生存偏倚，证实了这些关联。在抗菌治疗期间进行瓣膜置换手术将降低金黄色葡萄球菌PVE患者的死亡率，即使是那些没有心脏并发症证据的患者。
