Long-term prognosis of left-sided native-valve Staphylococcus aureus endocarditis

Background. - Staphylococcus aureus infective endocarditis (SATE) is a serious and common disease. Aims. - To assess the clinical and echocardiographic characteristics and prognostic factors of left-sided native-valve SATE, and to compare these characteristics between two periods (1990-2000 vs. 2001-2010). Methods. - This was a retrospective analysis of 162 cases of left-sided native-valve SATE among 1254 patients hospitalized for infective endocarditis (IE) between 1990 and 2010. Results. - SATE represented 18.1% of all cases of IE and 22.9% of cases of native-valve IE. Complications included heart failure in 44.7% of cases, acute renal failure in 23.3%, sepsis in 28.5%, neurological events in 35.8%, systemic embolic events in 54.9% and in-hospital mortality in 25.3%. Factors associated with in-hospital mortality were heart failure (odds ratio [OR] 2.5; P=0.04) and sepsis (OR 5.3; P=0.001). Long-term 5-year survival was 49.6 +/- 4.9%. Factors associated with long-term mortality were heart failure (OR 1.7; P=0.032), sepsis (OR 3; P=0.0001) and delayed surgery (OR 0.43; P=0.003). Comparison of the two periods revealed a significant increase in bivalvular involvement, valvular incompetence and acute renal failure from 2001 to 2010. No significant difference was observed in terms of in-hospital mortality rates (28.1% vs. 23.5%; P=0.58) and long-term 5-year survival (45.0 +/- 6.6% vs. 57.1 +/- 6.4%; P=0.33). Conclusion. - Mortality as a result of left-sided native-valve SATE remains high. Factors associated with in-hospital mortality are heart failure and sepsis. Factors associated with long-term mortality are heart failure, sepsis and delayed surgery. Despite progress in surgical techniques, in-hospital mortality and long-term mortality have not decreased significantly between the two periods. (C) 2015 Elsevier Masson SAS. All rights reserved.