Abstract：
BACKGROUND: Infective endocarditis (IE) caused by MRSA (methicillin-resistant Staphylococcus aureus) is associated with a high mortality rate. This study aimed to elucidate the characteristics of patients with MRSA-IE in Japan and identify the factors associated with prognosis.
METHODS: This retrospective study included patients with a confirmed diagnosis of IE caused by MRSA, between January 2015 and April 2019.
RESULTS: A total of 65 patients from 19 centers were included, with a mean age of 67 years and 26 % were female. Fifty percent of the patients with IE were had nosocomial infections and 25 % had prosthetic valve involvement. The most common comorbidities were hemodialysis (20 %) and diabetes (20 %). Congestive heart failure was present in 86 % of patients (NYHA class I, II: 48 %; III, IV: 38 %). The 30-day and in-hospital mortality rates were 29 % and 46 %, respectively. Multi-organ failure was the primary cause of death, accounting for 43 % of all causes of death. Prognostic factors for in-hospital mortality were age, disseminated intravascular coagulation, daptomycin and/or linezolid as initial antibiotic therapy, and surgery. Surgical treatment was associated with a lower mortality rate (odds ratio [OR], 0.026; 95 % confidence interval [CI], 0.002-0.382; p = 0.008 for 30-day mortality and OR, 0.130; 95 % CI; 0.029-0.584; p = 0.008 for in-hospital mortality).
CONCLUSIONS: Mortality due to MRSA-IE remains high. Surgical treatment is a significant prognostic predictor of MRSA-IE.
METHODS: This retrospective study included patients with a confirmed diagnosis of IE caused by MRSA, between January 2015 and April 2019.
RESULTS: A total of 65 patients from 19 centers were included, with a mean age of 67 years and 26 % were female. Fifty percent of the patients with IE were had nosocomial infections and 25 % had prosthetic valve involvement. The most common comorbidities were hemodialysis (20 %) and diabetes (20 %). Congestive heart failure was present in 86 % of patients (NYHA class I, II: 48 %; III, IV: 38 %). The 30-day and in-hospital mortality rates were 29 % and 46 %, respectively. Multi-organ failure was the primary cause of death, accounting for 43 % of all causes of death. Prognostic factors for in-hospital mortality were age, disseminated intravascular coagulation, daptomycin and/or linezolid as initial antibiotic therapy, and surgery. Surgical treatment was associated with a lower mortality rate (odds ratio [OR], 0.026; 95 % confidence interval [CI], 0.002-0.382; p = 0.008 for 30-day mortality and OR, 0.130; 95 % CI; 0.029-0.584; p = 0.008 for in-hospital mortality).
CONCLUSIONS: Mortality due to MRSA-IE remains high. Surgical treatment is a significant prognostic predictor of MRSA-IE.
摘要：
背景：由MRSA（耐甲氧西林金黄色葡萄球菌）引起的感染性心内膜炎（IE）与高死亡率相关。本研究旨在阐明日本MRSA-IE患者的特征并确定与预后相关的因素。
方法：这项回顾性研究包括确诊为MRSA所致IE的患者，2015年1月至2019年4月。
结果：共包括来自19个中心的65名患者，平均年龄67岁，26%为女性。50％的IE患者有医院感染，25％的患者有人工瓣膜受累。最常见的合并症是血液透析（20％）和糖尿病（20％）。86％的患者存在充血性心力衰竭（NYHA一级，II:48%;III,IV：38%）。30天和住院死亡率分别为29％和46％，分别。多器官衰竭是死亡的主要原因，占所有死因的43%。住院死亡率的预后因素是年龄，弥散性血管内凝血,达托霉素和/或利奈唑胺作为初始抗生素治疗，和手术。手术治疗与较低的死亡率相关(比值比[OR]，0.026；95%置信区间[CI]，0.002-0.382；30天死亡率和OR的p=0.008，0.130；95%CI；0.029-0.584；住院死亡率p=0.008）。
结论：MRSA-IE导致的死亡率仍然很高。手术治疗是预测MRSA-IE预后的重要指标。
方法：这项回顾性研究包括确诊为MRSA所致IE的患者，2015年1月至2019年4月。
结果：共包括来自19个中心的65名患者，平均年龄67岁，26%为女性。50％的IE患者有医院感染，25％的患者有人工瓣膜受累。最常见的合并症是血液透析（20％）和糖尿病（20％）。86％的患者存在充血性心力衰竭（NYHA一级，II:48%;III,IV：38%）。30天和住院死亡率分别为29％和46％，分别。多器官衰竭是死亡的主要原因，占所有死因的43%。住院死亡率的预后因素是年龄，弥散性血管内凝血,达托霉素和/或利奈唑胺作为初始抗生素治疗，和手术。手术治疗与较低的死亡率相关(比值比[OR]，0.026；95%置信区间[CI]，0.002-0.382；30天死亡率和OR的p=0.008，0.130；95%CI；0.029-0.584；住院死亡率p=0.008）。
结论：MRSA-IE导致的死亡率仍然很高。手术治疗是预测MRSA-IE预后的重要指标。
