Staphylococcus lugdunensis infective endocarditis: a multicentre international observational study

Staphylococcus lugdunensis (SL) can cause infective endocarditis (IE), with unusually high complication and mortality rates. According to the 2023 Duke-ISCVID criteria, blood cultures positive for SL now count as a major microbiological criterion.

Our aim was to determine the contemporary characteristics of SLIE, and to identify the factors associated with all-cause in-hospital mortality.

Patients with definite SLIE between 2010 and 2024 were included in a collaborative study involving 17 centres in France, Spain, Brazil, Italy, and Ireland.

We collected data on 112 patients with definite SLIE. Mean age was 67 ± 18 years, and 76 (67.9%) were males. Nosocomial and healthcare-related non-nosocomial SLIE accounted for 15.2% and 16.1% of cases, respectively. Prosthetic valves and cardiac implantable electronic devices (CIED) were involved in 36.6% and 10.7% of cases, respectively. Emboli occurred in 50%, heart failure in 32%, acute kidney injury in 39.4%, and perivalvular abscesses in 20.5% of cases. All strains were methicillin susceptible. Valve surgery was performed in 47 (42%) and CIED removal in 10 (8.9%) patients. All-cause in-hospital mortality was 29.5%. Variables associated with mortality were age (OR 1.10 per one-year increment, 95%CI [1.08-1.31], p < 0.001), malignancy (OR 26.22, [3.78-181.72], p < 0.001), a new severe mitral regurgitation (OR 17.10, [2.81-104.09], p = 0.002), paravalvular abscess (OR 63.40, [6.24-644.03], p < 0.001), and new high-degree atrioventricular block (OR 27.76, [2.49-309.82], p = 0.007).

This international multicentre study confirms that SLIE mimics Staphylococcus aureus IE, particularly with regard to aggressiveness, healthcare-related acquisition, complications, and mortality. Of note, all SL isolates were methicillin-susceptible.