Predictors of death and impact of surgery in Staphylococcus aureus infective endocarditis

Background. We studied a large cohort of adults with Staphylococcus aureus infective endocarditis to evaluate the predictors of outcome and to establish whether early surgery is associated with reduced mortality. Methods. The study prospectively enrolled 116 consecutive patients with definite S aureus infective endocarditis, according to Duke criteria and examined by transthoracic and transesophageal echocardiography. Results. The in-hospital mortality rate was 26%, and the 36-month survival rate was 57% +/- 5%. Multivariate analyses identified comorbidity index, congestive heart failure, severe sepsis, prosthetic valve infective endocarditis, and major neurologic events as predictors of in-hospital mortality; severe sepsis and comorbidity index as predictors of overall mortality; and the comorbidity index as a predictor of late mortality. In unadjusted analyses, early surgery performed in 47% of patients was associated with lower in-hospital mortality (16% versus 34%; p = 0.034) and with better 36-month survival (77% +/- 6% versus 39% +/- 7%; p < 0.001). After adjustment of baseline variables related to mortality, early surgery remained associated with reduced overall mortality. Conclusions. Prognosis of S aureus infective endocarditis remains poor, related to the comorbidities, presence of congestive heart failure, severe sepsis, major neurologic events, and prosthetic valve. Early surgery is independently associated with reduced overall mortality and should be considered in selected cases to improve the outcome.