Background

Coagulase-negative staphylococci (CoNS) are an increasingly common cause of infective endocarditis (IE) and lack recent data from large studies.

Objectives

Our aim was to describe the epidemiology, clinical characteristics, and outcomes of staphylococcal IE in a contemporary nationwide cohort study, while comparing coagulase-negative staphylococcal IE (CoNSIE) to IE from Staphylococcus aureus (SAIE), and among IE caused by Staphylococcus epidermidis (SE), S. lugdunensis (SL), and other CoNS.

Methods

We completed a post hoc analysis of a prospectively collected cohort of 4,567 consecutive definitive IE episodes from 44 Spanish centers between 2008 and 2022 (GAMES ["Grupos de Apoyo al Manejo de la Endocarditis Infecciosa en España"] cohort). A total of 842 cases of CoNSIE were compared with 1,109 cases of SAIE. Additionally, 647 episodes caused by SE were compared with 54 caused by SL and 109 caused by 9 other known CoNS species. Multivariate analyses were performed to investigate prognostic factors for in-hospital and 1-year mortality.

Results

Staphylococci accounted for 1,951 (42.7%) episodes of IE. The predominant CoNS etiology was SE (76.8%), followed by SL (6.4%), S. capitis (3.5%), S. haemolyticus (3.2%), S. hominis (3.2%), S. warneri (1.5%), and 5 other species. CoNSIE showed a distinct clinical profile from SAIE (older age, higher rates of prior heart disease, aortic and prosthetic valve involvement, nosocomial acquisition, methicillin resistance, intracardiac complications, and cardiac surgery), while in-hospital mortality was higher in SAIE (32.8% vs 37.1%; P = 0.049), with no significant differences in 1-year mortality. S. lugdunensis displayed a shorter course of infection and higher rates of leaflet perforation/rupture than S. epidermidis and other CoNS, but cardiac surgery rates (60.4% vs 61.1% vs 56.0%; P = 0.850), as well as in-hospital (33.1% vs 37.0% vs 27.5%; P = 0.540) and 1-year mortality rates were high and similar in all groups. Septic shock, heart failure, and cardiac surgery (protective) were consistently identified as independent prognostic factors, whereas none of the staphylococcal species were independently associated with mortality. Last, each 5-year study period was independently associated with a reduction in staphylococcal in-hospital and 1-year mortality.

Conclusions

CoNSIE was a relatively common (18.4%) and life-threatening entity with particularities by species yet generally high rates of surgery and mortality, although its prognosis improved over time.

中文翻译：

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凝固酶阴性葡萄球菌心内膜炎的当代情况：一项全国性的 GAMES 队列研究

 背景

凝固酶阴性葡萄球菌 （CoNS） 是感染性心内膜炎 （IE） 越来越常见的原因，并且缺乏来自大型研究的最新数据。

 目标

我们的目的是在一项当代全国性队列研究中描述葡萄球菌 IE 的流行病学、临床特征和结果，同时比较凝固酶阴性葡萄球菌 IE （CoNSIE） 与金黄色葡萄球菌 （SAIE） 的 IE，以及由表皮葡萄球菌 （SE）、路格敦葡萄球菌 （SL） 和其他 CoNS 引起的 IE。

 方法

我们完成了对 2008 年至 2022 年间来自 44 个西班牙中心的 4,567 例连续确定性 IE 发作的前瞻性队列的事后分析（GAMES [“Grupos de Apoyo al Manejo de la Endocarditis Infecciosa en España”] 队列）。共比较了 842 例 CoNSIE 与 1,109 例 SAIE。此外，将 SE 引起的 647 次发作与 SL 引起的 54 次和其他 9 种已知 CoNS 物种引起的 109 次发作进行了比较。进行多变量分析以调查住院和 1 年死亡率的预后因素。

 结果

葡萄球菌占 IE 的 1,951 次 （42.7%） 发作。主要的 CoNS 病因是 SE （76.8%），其次是 SL （6.4%）、头链球菌 （3.5%）、溶血性链球菌 （3.2%）、人链球菌 （3.2%）、华氏链球菌 （1.5%） 和其他 5 个物种。CoNSIE 显示出与 SAIE 不同的临床特征（年龄较大、既往心脏病发生率较高、主动脉瓣和人工瓣膜受累、院内获得、甲氧西林耐药、心内并发症和心脏手术），而 SAIE 的院内死亡率较高（32.8% 对 37.1%;P = 0.049），1 年死亡率无显著差异。与表皮链球菌 和其他 CoNS 相比，路邓链球菌的感染过程更短，瓣叶穿孔/破裂率更高，但心脏手术率 （60.4% 对 61.1% 对 56.0%; P = 0.850），以及住院 （33.1% 对 37.0% 对 27.5%;P = 0.540） 和 1 年死亡率均较高且在所有组中相似。感染性休克、心力衰竭和心脏手术 （保护性） 一直被确定为独立的预后因素，而没有一种葡萄球菌属与死亡率独立相关。最后，每个 5 年研究期与葡萄球菌住院和 1 年死亡率的降低独立相关。

 结论

CoNSIE 是一种相对常见 （18.4%） 且危及生命的实体，具有物种的特殊性，但手术率和死亡率通常很高，尽管其预后随着时间的推移而改善。