engleski

Comparison of Staphylococcus lugdunensis and Staphylococcus epidermidis native valve endocarditis from the International Collaboration on Endocarditis – Prospective Cohort Study

Staphylococcus lugdunensis native valve endocarditis (NVE) is rare and associated with an aggressive clinical course. Our current understanding of this disease is based on case reports and reviews of the literature. The purpose of this investigation is to compare the clinical features of S. lugdunensis and S. epidermidis NVE. The International Collaboration on Endocarditis – Prospective Cohort Study (ICE-PCS) is a cohort of >3000 patients with IE from 61 centers in 28 countries. The ICE – microbiology repository comprises a subset of bacterial isolates from ICE-PCS contributed by 18 centers in 12 countries. From the ICE-microbiology repository, there were 23 S. epidermidis and 4 S. lugdunensis NVE isolates available for comparison. All S. lugdunensis isolates were susceptible to penicillin compared to 4 (17%) S. epidermidis isolates. Patients with S. lugdunensis NVE were younger than patients with S. epidermidis NVE (median age 52 vs 73 years, respectively). Three of the 4 cases of S. lugdunensis NVE cases were community-acquired, while 65% of S. epidermidis cases were acquired in the healthcare setting. Healthcare-associated risks for staphylococcal infection were absent for patients with S. lugdunensis NVE. In contrast, hemodialysis dependence (17%), cardiac devices (17%), and receipt of invasive procedures (39%) were prominent characteristics of patients with S. epidermidis NVE. Complications occurred in a larger proportion of patients with S. lugdunensis NVE [systemic embolization 2 (50%) ; heart failure 3 (75%)] than S. epidermidis NVE [systemic embolization 3 (13%) ; heart failure 11 (48%)]. All 4 (100%) patients with S. lugdunensis NVE underwent surgery compared to 14 (61%) S. epidermidis NVE patients. The rate of death was similar in S. lugdunensis and S. epidermidis NVE [1 (25%) vs 6 (26%)]. Given the small sample size, p-values were not significant for all analyses. S. lugdunensis NVE is associated with an aggressive clinical course and a high rate of surgery. Clinicians should be suspicious for S. lugdunensis in patients who present with coagulase-negative staphylococcal NVE from the community, without healthcare associated risks.

native valve endocarditis; Staphylococcus lugdunensis; Staphylococcus epidermidis

DOI 10.1007/s00392-007-0534-8