Epidemiology and management of Staphylococcus Aureus infective endocarditis in adult patients with congenital heart disease: A single tertiary center experience. (1st August 2022)

• Record Type: Journal Article
• Authors: Arvanitaki, Alexandra; Ibrahim, Wasyla; Shore, Darryl; Diller, Gerhard-Paul; Li, Wei; Rafiq, Isma; Gatzoulis, Michael; Montanaro, Claudia
• Is Part Of: International journal of cardiology. Volume 360(2022)
• Page Start: 23
• Page End: 28
• Publication Date: 2022-08-01
• Subjects: Infective endocarditis -- Staphylococcus Aureus -- Adult congenital heart disease -- Epidemiology -- Management -- Mortality; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2022.04.078
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Infective endocarditis (IE) is a potentially lethal disease for adults with congenital heart disease (ACHD). Staphylococcus aureus (SA) is one of the commonest pathogens, identified in patients with ACHD and IE. This study aims to analyse the epidemiology, clinical characteristics and in-hospital management of IE due to SA (SAIE) in ACHD. Methods: This is a single center retrospective study on documented episodes of SAIE in ACHD patients, treated at the Royal Brompton Hospital between 1999 and February 2020. Results: Thirty-seven ACHD patients had an episode of SAIE (mean age 35.5 ± 14.9 years). More than half (51.3%), had a cardiac lesion of at least moderate complexity, with left ventricular outflow tract lesions being the most frequent. Twenty-four (64.9%) patients had a history of at least one previous open-heart surgery, and prosthetic material was used in 20 patients. A predisposing event was identified in 11 episodes (29.7%). Surgery was performed during the same admission in 24 (64.9%) patients, with early surgery (≤ 7 days from admission) performed in 12 patients. Early operation was associated with a shorter in-hospital stay compared to a later operation during the same admission or medical management [28.5 (IQR 23) vs. 43.5 (IQR 30) days, P = 0.028]. In-hospital mortality was 8.1%. Renal dysfunction at admission was associated with in-hospital multiorgan complications and/or death (OR 7.50, 95% CI, 1.18–47.67, P = 0.03). Conclusion: SAIE remains a life-threatening complication, necessitating cardiac surgery in the majority of ACHD patients. Ongoing educational investment on prevention and timely SAIE detection is warranted. Graphical abstract: Unlabelled Image Highlights: Staphylococcus aureus infective endocarditis (SAIE) is a life-threatening complication in adults with congenital heart disease (ACHD). Almost two thirds of ACHD patients infected with SAIE in our cohort required surgery during admission. In-hospital mortality due to SAIE was 8.1% in this cohort. Ongoing educational investment on how to prevent and timely detect SAIE is warranted.