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Methicillin Resistance and Risk Factors for Embolism in Staphylococcus aureus Infective Endocarditis

Published online by Cambridge University Press:  02 January 2015

Ron-Bin Hsu  and
Fang-Yue Lin
Ron-Bin Hsu
Affiliation:
Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan, Republic of China
Fang-Yue Lin*
Affiliation:
Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan, Republic of China
*
National Taiwan University Hospital, No.7, Chung-Shan S Rd, Taipei, Taiwan 100, ROC. (fylinl@ha.mc.ntu.edu.tw)
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Abstract

Objective.

Infective endocarditis caused by Staphylococcus aureus is an ominous prognosis associated with a high prevalence of embolic episodes and neurological involvement. Whether methicillin resistance decreases the risk of embolism in infective endocarditis is unclear. We sought to assess the association between methicillin resistance and risk factors for embolism in S. aureus infective endocarditis.

Design.

Retrospective chart review. Data from patients with infective endocarditis due to methicillin-resistant S. aureus were compared with data from patients with endocarditis due to methicillin-susceptible S. aureus. Logistic regression was used to identify independent risk factors for embolism.

Setting.

A 2,000-bed, university-affiliated tertiary care hospital.

Patients.

Between 1995 and 2005, 123 patients with S. aureus infective endocarditis were included in the study. There were 74 male patients and 49 female patients, with a median age of 54 years (range, 0-89 years).

Results.

Of 123 infections, 30 (24%) were nosocomial infections, and 14 (11%) were prosthetic valve infections. Of 123 S. aureus isolates, 48 (39%) were methicillin resistant. In total, embolism occurred in 45 (37%) of these patients: pulmonary embolism in 22 (18%), cerebral embolism in 21 (17%), and peripheral embolism in 6 (5%). The independent risk factors for an embolism were injection drug use, presence of a cardiac vegetation with a size of 10 mm or greater, and absence of nosocomial infection. For 83 patients with aortic or mitral infective endocarditis, independent risk factors for an embolism were the presence of a cardiac vegetation with a size of 10 mm or greater and endocarditis due to methicillin-susceptible S. aureus. Overall, in-hospital death occurred for 32 (26%) of 123 Patients. Methicillin-resistant infection was not an independent risk factor for death.

Conclusions.

Methicillin-resistant S. aureus infection was associated with decreased risk of embolism in left-side endocarditis, but was not associated with in-hospital death.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 7 , July 2007 , pp. 860 - 866
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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References

1.Netzer, RO, Altwegg, SC, Zollinger, E, Tauber, M, Carrel, T, Seiler, C. Infective endocarditis: determinants of long term outcome. Heart 2002;88:61–66.CrossRefGoogle ScholarPubMed
2.Bouza, E, Menasalvas, A, Munoz, P, Vasallo, FJ, del Mar Moreno, M, Garcia Fernandez, MA. Infective endocarditis—a prospective study at the end of the twentieth century, new predisposing conditions, new etiologie agents, and still a high mortality. Medicine 2001;80:298–307.CrossRefGoogle Scholar
3.Hoen, B, Alia, F, Selton-Suty, C, et al; Association pour l'Etude et la Prevention de l'Endocardite Infectieuse (AEPEI) Study Group. Changing profile of infective endocarditis: results of a 1-year survey in France. JAMA 2002;288:75–81.CrossRefGoogle Scholar
4.Espersen, F, Frimodt-Moller, N. Staphylococcus aureus endocarditis. Arch Intern Med 1986;146:1118–1121.CrossRefGoogle ScholarPubMed
5.Cabell, CH, Jollis, JG, Peterson, GE, et al.Changing patient characteristics and the effect on mortality in endocarditis. Arch Intern Med 2002;162:90–94.CrossRefGoogle ScholarPubMed
6.Roder, BL, Wandall, DA, Frimodt-Moller, N, Espersen, F, Skinhoj, P, Rosdahl, VT. Clinical features of Staphylococcus aureus endocarditis: a 10-year experience in Denmark. Arch Intern Med 1999;159:462–469.CrossRefGoogle ScholarPubMed
7.Sanabria, TJ, Alpert, JS, Goldberg, R, Pape, LA, Cheeseman, SH. Increasing frequency of staphylococcal infective endocarditis. Arch Intern Med 1990;150:1305–1309.CrossRefGoogle ScholarPubMed
8.Fowler, VG Jr, Sanders, LL, Kong, LK, et al.Infective endocarditis due to Staphylococcus aureus: 59 prospectively identified cases with follow-up. Clin Infect Dis 1999;28:106–114.CrossRefGoogle ScholarPubMed
9.Salmenlinna, S, Lyytikainen, O, Vuopio-Varkila, J. Community-acquired methicillin-resistant Staphylococcus aureus, Finland. Emerg Infect Dis 2002;8:602–607.CrossRefGoogle ScholarPubMed
10.Gentry, CA, Rodvold, KA, Novak, RM, Hershow, RC, Naderer, OJ. Retrospective evaluation of therapies for Staphylococcus aureus endocarditis. Pharmacotherapy 1997;17:990–997.CrossRefGoogle ScholarPubMed
11.Levine, DP, Fromm, BS, Reddy, BR. Slow response to vancomycin or vancomycin plus rifampin in methicillin-resistant Staphylococcus aureus endocarditis. Ann Intern Med 1991;115:674–680.CrossRefGoogle ScholarPubMed
12.Miro, JM, Anguera, I, Cabell, CH, et al; International Collaboration on Endocarditis Merged Database Study Group. Staphylococcus aureus native valve infective endocarditis: report of 566 episodes from the International Collaboration on Endocarditis Merged Database. Clin Infect Dis 2005;41:507–514.CrossRefGoogle ScholarPubMed
13.Fowler, VG Jr, Miro, JM, Hoen, B, et al; ICE Investigators. Staphylococcus aureus endocarditis: a consequence of medical progress. JAMA 2005;293:3012–3021.CrossRefGoogle ScholarPubMed
14.Li, JS, Sexton, DJ, Mick, N, et al.Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis 2000;30:633–638.CrossRefGoogle Scholar
15.Wang, JT, Chang, SC, Ko, WJ, et al.A hospital-acquired outbreak of methicillin-resistant Staphylococcus aureus infection initiated by a surgeon carrier. J Hosp Infect 2001;47:104–109.CrossRefGoogle ScholarPubMed
16.National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Disk Susceptibility Tests. 6th Edition. Approved Standard. Wayne, PA: NCCLS; 1998. M2–A6.Google Scholar
17.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.CrossRefGoogle ScholarPubMed
18.McGowan, JE Jr, Tenover, FC. Control of antimicrobial resistance in the health care system. Infect Dis Clin North Am 1997;11:297–311.CrossRefGoogle ScholarPubMed
19.Hsueh, PR, Chen, ML, Sun, CC, et al.Antimicrobial drug resistance in pathogens causing nosocomial infections at a university hospital in Taiwan, 1981-1999. Emerg Infect Dis 2002;8:63–68.CrossRefGoogle Scholar
20.Wang, JT, Chen, YC, Yang, TL, Chang, SC. Molecular epidemiology and antimicrobial susceptibility of methicillin-resistant Staphylococcus aureus in Taiwan. Diagn Microbiol Infect Dis 2002;42:199–203.CrossRefGoogle ScholarPubMed
21.Diekema, DJ, Pfaller, MA, Turnidge, J, et al; SENTRY Participants Group. Genetic relatedness of multidrug-resistant, methicillin (oxacillin)-resistant Staphylococcus aureus bloodstream isolates from SENTRY Antimicrobial Resistance Surveillance Centers worldwide, 1998. Microb Drug Resist 2000;6:213–221.CrossRefGoogle ScholarPubMed
22.Bishara, J, Leibovici, L, Gartman-Israel, D, et al.Long-term outcome of infective endocarditis: the impact of early surgical intervention. Clin Infect Dis 2001;33:1636–1643.CrossRefGoogle ScholarPubMed
23.Roghmann, MC. Predicting methicillin resistance and the effect of inadequate empiric therapy on survival in patients with Staphylococcus aureus bacteremia. Arch Intern Med 2000;160:1001–1004.CrossRefGoogle Scholar
24.Talon, D, Woronoff-Lemsi, MC, Limat, S, et al.The impact of resistance to methicillin in Staphylococcus aureus bacteremia on mortality. Eur J Intern Med 2002;13:31–36.CrossRefGoogle ScholarPubMed
25.Soriano, A, Martinez, JA, Mensa, J, et al.Pathogenic significance of methicillin resistance for patients with Staphylococcus aureus bacteremia. Clin Infect Dis 2000;30:368–373.CrossRefGoogle ScholarPubMed
26.Harbarth, S, Rutschmann, O, Sudre, P, Pittet, D. Impact of methicillin resistance on the outcome of patients with bacteremia caused by Staphylococcus aureus. Arch Intern Med 1998;158:182–189.CrossRefGoogle ScholarPubMed
27.Romero-Vivas, J, Rubio, M, Fernandez, C, Picazo, JJ. Mortality associated with nosocomial bacteremia due to methicillin-resistant Staphylococcus aureus. Clin Infect Dis 1995;21:1417–23.CrossRefGoogle ScholarPubMed
28.Lewis, E, Saravolatz, LD. Comparison of methicillin-resistant and meth-icillin-sensitive Staphylococcus aureus bacteremia. Am J Infect Control 1985;13:109–114.CrossRefGoogle ScholarPubMed
29.Gentry, CA, Rodvold, KA, Novak, RM, Hershow, RC, Naderer, OJ. Retrospective evaluation of therapies for Staphylococcus aureus endocarditis. Pharmacotherapy 1997;17:990–997.CrossRefGoogle ScholarPubMed
30.Heiro, M, Nikoskelainen, J, Engblom, E, Kotilainen, E, Maritila, R, Koti-lainen, P. Neurologic manifestations of infective endocarditis: a 17-year experience in a teaching hospital in Finland. Arch Intern Med 2000;160:2781–2787.CrossRefGoogle Scholar
31.Roder, BL, Wandall, DA, Espersen, F, Frimodt-Moller, N, Skinhoj, P, Rosdahl, VT. Neurologic manifestations in Staphylococcus aureus endocarditis: a review of 260 bacteremic cases in nondrug addicts. Am J Med 1997;102:379–386.CrossRefGoogle ScholarPubMed
32.Millaire, A, Leroy, O, Gaday, V, et al.Incidence and prognosis of embolic events and metastatic infections in infective endocarditis. Eur Heart J 1997;18:677–684.CrossRefGoogle ScholarPubMed
33.Deprele, C, Berthelot, P, Lemetayer, F, et al.Risk factors for systemic emboli in infective endocarditis. Clin Microbiol Infect 2004;10:46–53.CrossRefGoogle ScholarPubMed
34.Vilacosta, I, Graupner, C, San Roman, JA, et al.Risk of embolization after institution of antibiotic therapy for infective endocarditis. J Am Coll Cardiol 2002;39:1489–1495.CrossRefGoogle ScholarPubMed
35.Ringberg, H, Thoren, A, Lilija, B. Metastatic complications of Staphylococcus aureus septicemia: to seek is to find. Infection 2000;28:132–136.CrossRefGoogle ScholarPubMed
36.Travers, K, Barza, M. Morbidity of infections caused by antimicrobial-resistant bacteria. Clin Infect Dis 2002;34:S131–S134.CrossRefGoogle ScholarPubMed
37.Moreillon, P, Entenza, JM, Francioli, P, et al.Role of Staphylococcus aureus coagulase and clumping factor in pathogenesis of experimental endocarditis. Infect Immun 1995;63:4738–4743.CrossRefGoogle ScholarPubMed
38.Siboo, IR, Cheung, AL, Bayer, AS, Sullam, PM. Clumping factor A mediates binding of Staphylococcus aureus to human platelets. Infect Immun 2001;69:3120–3127.CrossRefGoogle ScholarPubMed
39.Niemann, S, Spehr, N, Van Aken, H, et al.Soluble fibrin is the main mediator of Staphylococcus aureus adhesion to platelets. Circulation 2004;110:193–200.CrossRefGoogle ScholarPubMed
40.Vaudaux, PE, Monzillo, V, Francois, P, Lew, DP, Foster, TJ, Berger-Bachi, B. Introduction of the mec element (methicillin resistance) into Staphylococcus aureus alters in vitro functional activities of fibrinogen and fibronectin adhesins. Antimicrob Agents Chemother 1998;42:564–570.CrossRefGoogle ScholarPubMed