S aureus endocarditis: a review and plea for early surgery

In a study of 31 cases and a review of the literature, Staphylococcus aureus endocarditis was distinguished from that due to other organisms by the absence of prior valvular disease, by the presence of debilitating illness or acute onset, and by a toxic fulminant course. Availability of semi-synthetic penicillins decreased mortality from 90% to about 50%, with death due to heart failure rather than sepsis. Valvular replacement may improve survival if employed at the first signs of cardiac decompensation, rather than after medical therapy has failed to stabilize a downhill course.