Abstract：
OBJECTIVE: Staphylococcus aureus prosthetic valve endocarditis (SAPVE) is a serious infection with high mortality. The main objective of this study was to identify factors associated with in-hospital mortality.
METHODS: From January 2008 to December 2021, consecutive patients from a Spanish cohort of infective endocarditis with a definitive diagnosis of SAPVE were analyzed.
RESULTS: During the study period, 219 cases of definitive SAPVE were diagnosed, which accounted for 16.7% of a total of 1309 cases of definitive prosthetic valve endocarditis (PVE). Patients presented advanced age and marked comorbidity. There was a higher incidence of persistent bacteremia, septic shock, stroke, and acute kidney injury than in cases of PVE caused by other microorganisms. Methicillin resistance was not associated with differences in clinical presentation, echocardiographic findings, or mortality. Only 50.6% of the patients with surgical indications (88 patients) underwent surgery. Overall, in-hospital mortality was 47.9%. The variables associated with in-hospital mortality were age (OR:1.03, 95% CI: 1.00-1.05; p = 0.016), heart failure (OR:2.86, 95% CI: 1.53-5.32; p = 0.001), acute kidney injury (OR:2.42, 95%CI:1.28-4.58; p = 0.006), stroke (OR:3.53, 95%CI:1.79-6.96; p < 0.001) and surgery indicated but not performed (OR:2.01, 95%CI:1.06-3.8; p = 0.030). On the other hand, the performance of surgery per se in patients with SAPVE, regardless of whether there was a surgical indication according to the guidelines, was not associated with a reduction in in-hospital mortality.
CONCLUSIONS: SAPVE is characterized by high mortality, which is more marked in patients who present a surgical indication but do not undergo surgery.
METHODS: From January 2008 to December 2021, consecutive patients from a Spanish cohort of infective endocarditis with a definitive diagnosis of SAPVE were analyzed.
RESULTS: During the study period, 219 cases of definitive SAPVE were diagnosed, which accounted for 16.7% of a total of 1309 cases of definitive prosthetic valve endocarditis (PVE). Patients presented advanced age and marked comorbidity. There was a higher incidence of persistent bacteremia, septic shock, stroke, and acute kidney injury than in cases of PVE caused by other microorganisms. Methicillin resistance was not associated with differences in clinical presentation, echocardiographic findings, or mortality. Only 50.6% of the patients with surgical indications (88 patients) underwent surgery. Overall, in-hospital mortality was 47.9%. The variables associated with in-hospital mortality were age (OR:1.03, 95% CI: 1.00-1.05; p = 0.016), heart failure (OR:2.86, 95% CI: 1.53-5.32; p = 0.001), acute kidney injury (OR:2.42, 95%CI:1.28-4.58; p = 0.006), stroke (OR:3.53, 95%CI:1.79-6.96; p < 0.001) and surgery indicated but not performed (OR:2.01, 95%CI:1.06-3.8; p = 0.030). On the other hand, the performance of surgery per se in patients with SAPVE, regardless of whether there was a surgical indication according to the guidelines, was not associated with a reduction in in-hospital mortality.
CONCLUSIONS: SAPVE is characterized by high mortality, which is more marked in patients who present a surgical indication but do not undergo surgery.
摘要：
目的：金黄色葡萄球菌人工瓣膜心内膜炎（SAPVE）是一种严重感染，死亡率高。这项研究的主要目的是确定与住院死亡率相关的因素。
方法：从2008年1月至2021年12月，对西班牙感染性心内膜炎队列中明确诊断为SAPVE的连续患者进行分析。
结果：在研究期间，诊断为明确的SAPVE219例，占1309例确定性人工瓣膜心内膜炎（PVE）的16.7％。患者表现为高龄和明显的合并症。持续性菌血症的发生率较高，感染性休克,中风,与其他微生物引起的PVE相比，急性肾损伤。甲氧西林耐药与临床表现差异无关，超声心动图检查结果,或死亡率。只有50.6%的有手术指征的患者(88例患者)接受了手术。总的来说,院内死亡率为47.9%.与住院死亡率相关的变量是年龄(OR:1.03,95%CI:1.00-1.05;p=0.016),心力衰竭（OR：2.86，95％CI：1.53-5.32；p=0.001），急性肾损伤（OR：2.42，95CI：1.28-4.58；p=0.006），卒中(OR:3.53,95CI:1.79-6.96;p<0.001)和显示手术但未进行手术(OR:2.01,95CI:1.06-3.8;p=0.030).另一方面,手术本身在SAPVE患者中的表现，无论根据指南是否有手术指征，与住院死亡率的降低无关.
结论：SAPVE的特点是死亡率高，这在有手术指征但未接受手术的患者中更为明显。
方法：从2008年1月至2021年12月，对西班牙感染性心内膜炎队列中明确诊断为SAPVE的连续患者进行分析。
结果：在研究期间，诊断为明确的SAPVE219例，占1309例确定性人工瓣膜心内膜炎（PVE）的16.7％。患者表现为高龄和明显的合并症。持续性菌血症的发生率较高，感染性休克,中风,与其他微生物引起的PVE相比，急性肾损伤。甲氧西林耐药与临床表现差异无关，超声心动图检查结果,或死亡率。只有50.6%的有手术指征的患者(88例患者)接受了手术。总的来说,院内死亡率为47.9%.与住院死亡率相关的变量是年龄(OR:1.03,95%CI:1.00-1.05;p=0.016),心力衰竭（OR：2.86，95％CI：1.53-5.32；p=0.001），急性肾损伤（OR：2.42，95CI：1.28-4.58；p=0.006），卒中(OR:3.53,95CI:1.79-6.96;p<0.001)和显示手术但未进行手术(OR:2.01,95CI:1.06-3.8;p=0.030).另一方面,手术本身在SAPVE患者中的表现，无论根据指南是否有手术指征，与住院死亡率的降低无关.
结论：SAPVE的特点是死亡率高，这在有手术指征但未接受手术的患者中更为明显。
