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Seven cases of surgical native valve endocarditis caused by coagulase-negative staphylococci: An underappreciated
P S Miele1, P K Kogulan, C S Levy
1Washington Hospital Center, Washington, DC 20010, USA.
Background:
Native valve endocarditis caused by coagulase-negative staphylococci is uncommon and the diagnosis is infrequently considered. The disease, however, appears to be increasing in frequency and can pursue an aggressive clinical course. We report the clinical features of 7 cases of coagulase-negative staphylococcal native valve endocarditis (CNS-NVE) seen at 1 institution with a large cardiovascular referral base over a 10-month period. All cases required valve replacement surgery.
Methods:
Clinical history, echocardiograms, and microbiologic and histopathologic data were reviewed for 7 patients with surgical CNS-NVE.
Results:
Four patients had intravenous central catheters, and 1 had recent surgery, whereas the remaining 2 had no identifiable risk factors. Presentations ranged from subacute (4 cases) to acute with complications (3 cases). Complications included congestive heart failure, stroke, and heart block. Echocardiography demonstrated valvular lesions in all 7 cases. Valve pathologic study demonstrated gram-positive cocci in all 7 cases; blood cultures grew coagulase-negative staphylococci in 6 cases and valve cultures grew Staphylococcus epidermidis in 5 cases.
Conclusions:
Coagulase-negative staphylococci, including S epidermidis, can cause severe native valve endocarditis requiring valve replacement. The increasing use of intravascular access devices in the community may herald an increase in the incidence of CNS-NVE. A high index of diagnostic suspicion in the appropriate clinical setting is critical for optimal management.
Insights
Coagulase-negative staphylococci can cause severe native valve endocarditis, often requiring surgery. Increased use of IV devices may lead to more cases, necessitating high diagnostic suspicion.
Area of Science:
- Cardiology
- Infectious Diseases
- Microbiology
Background:
- Coagulase-negative staphylococci (CNS) native valve endocarditis (NVE) is uncommon but increasingly recognized.
- This condition can present aggressively, often requiring surgical intervention.
Observation:
- Seven cases of CNS-NVE requiring valve replacement were identified over 10 months.
- Risk factors included intravenous central catheters (4 cases) and recent surgery (1 case).
- Presentations varied from subacute to acute with severe complications like heart failure, stroke, and heart block.
Findings:
- Echocardiography confirmed valvular lesions in all patients.
- Histopathology revealed gram-positive cocci, and blood/valve cultures identified CNS, including Staphylococcus epidermidis.
- All seven patients ultimately required valve replacement surgery.
Implications:
- CNS, particularly S. epidermidis, is a significant cause of severe NVE.
- The rise in intravascular access devices may contribute to increased CNS-NVE incidence.
- Prompt diagnosis and management are crucial for patients with suspected CNS-NVE.
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