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Microbiological etiology in prosthetic valve endocarditis: A nationwide registry study
Blerand Berisha1,2, Sigurdur Ragnarsson3, Lars Olaison4
1Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
Background:
Prosthetic valve endocarditis (PVE) is a feared complication after heart valve surgery. Studies on differences in bacteriology in various types of PVE are limited.
Objectives:
This study aimed to investigate the microbiology of PVE depending on the type of prosthetic valve and timing of diagnosis.
Methods:
A retrospective study based on the Swedish Registry on Infective Endocarditis focusing on PVE was conducted. The cohort was divided into mechanical and bioprosthetic valves; into endocarditis localization in the aortic, mitral, or tricuspid valve; and into early and late PVE. The microbiology in these groups was compared. Predictors of Staphylococcus aureus as the cause of PVE were examined by multivariable logistic regression.
Results:
A total of 780 episodes of PVE in 749 patients were compared regarding the distribution of causative microbiological agents. The most common agents included alpha-hemolytic streptococci (29%), S. aureus (22%), enterococci (14%), coagulase-negative staphylococci (CoNS) (12%), and Cutibacterium acnes (6%). S. aureus was more commonly found on mechanical valves compared to bioprosthetic ones (36% vs. 17%, p < 0.001) whereas alpha-hemolytic streptococci, enterococci, and CoNS were more common on bioprosthetic valves. There were no significant differences in the microbiology of PVE affecting mitral or aortic valves or in cases of early and late PVE. Predictors for S. aureus as the cause of PVE were end-stage renal disease, intravenous drug use, mechanical valve, and tricuspid localization of endocarditis.
Conclusions:
The type of prosthetic heart valve is associated with the causative pathogen. Patients with mechanical valves are more likely to have PVE caused by S. aureus.
Insights
Prosthetic valve endocarditis (PVE) differs based on valve type. Mechanical valves are more often linked to Staphylococcus aureus infections, while bioprosthetic valves show higher rates of other bacteria. This impacts treatment strategies for PVE.
Area of Science:
- Cardiology
- Infectious Diseases
- Microbiology
Background:
- Prosthetic valve endocarditis (PVE) is a serious complication following heart valve replacement surgery.
- Limited data exists on how the microbiology of PVE varies with prosthetic valve type.
Purpose of the Study:
- To investigate the microbiological differences in PVE based on prosthetic valve type (mechanical vs. bioprosthetic) and diagnosis timing.
- To identify predictors for Staphylococcus aureus as a causative agent in PVE.
Main Methods:
- A retrospective analysis of 780 PVE episodes from the Swedish Registry on Infective Endocarditis.
- Patients were categorized by valve type, localization (aortic, mitral, tricuspid), and timing (early vs. late PVE).
- Microbiological data was compared across groups, and multivariable logistic regression identified predictors of S. aureus PVE.
Main Results:
- Staphylococcus aureus was more prevalent in mechanical valves (36%) compared to bioprosthetic valves (17%).
- Alpha-hemolytic streptococci, enterococci, and coagulase-negative staphylococci were more common in bioprosthetic valve endocarditis.
- No significant microbiological differences were found based on valve localization or PVE timing (early vs. late).
- Independent predictors for S. aureus PVE included end-stage renal disease, IV drug use, mechanical valve presence, and tricuspid valve localization.
Conclusions:
- The causative pathogen in PVE is significantly associated with the type of prosthetic heart valve.
- Mechanical heart valves are linked to a higher likelihood of PVE caused by Staphylococcus aureus.
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