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Increase in native valve endocarditis caused by coagulase negative staphylococci: an Anglo-French clinical and
Abstract:
Native valve endocarditis caused by coagulase negative staphylococci has become more common. A study of 35 cases showed that the infections were usually acquired in the community and occurred in men (mean age 51 years). A pre-existing cardiac abnormality (mitral leaflet prolapse in a third of patients) was detected in 26 (74%). The source of the organisms in the community acquired infections was assumed to be the skin, though lesions were seldom demonstrated; most hospital acquired infections resulted from intravenous devices. Community acquired organisms were usually sensitive to penicillin, whereas those acquired in hospital were often multiresistant. Most infections were caused by Staphylococcus epidermidis. The frequency of acute presentation (26%) and of major neurological abnormality (23%), together with the need for valve replacement (often emergency) (51%) and the mortality (36%) suggest that coagulase negative staphylococci can be virulent aggressive pathogens, mimicking Staphylococcus aureus.
Insights
Native valve endocarditis from coagulase-negative staphylococci is increasing. These aggressive pathogens, often Staphylococcus epidermidis, cause severe infections, requiring valve replacement and leading to high mortality.
Area of Science:
- Cardiology
- Infectious Diseases
- Microbiology
Background:
- Native valve endocarditis (NVE) caused by coagulase-negative staphylococci (CoNS) is increasingly prevalent.
- CoNS infections often occur in community settings and affect middle-aged men, frequently with underlying cardiac conditions like mitral valve prolapse.
Purpose of the Study:
- To investigate the clinical characteristics, sources, antimicrobial susceptibility, and outcomes of NVE caused by CoNS.
Main Methods:
- Retrospective study of 35 patients with NVE due to CoNS.
- Analysis of patient demographics, clinical presentation, cardiac abnormalities, infection source, organism susceptibility, and treatment outcomes.
Main Results:
- Infections were predominantly community-acquired (74%), with Staphylococcus epidermidis being the most common pathogen.
- Community-acquired strains were generally penicillin-sensitive, while hospital-acquired strains showed multi-resistance.
- Significant rates of acute presentation (26%), neurological complications (23%), emergency valve replacement (51%), and high mortality (36%) were observed.
Conclusions:
- Coagulase-negative staphylococci are virulent pathogens in NVE, capable of causing severe, aggressive infections that mimic Staphylococcus aureus.
- Prompt diagnosis and management are crucial due to the high morbidity and mortality associated with CoNS endocarditis.