Surgery in Staphylococcus aureus Infective Endocarditis: Clinical Outcomes, Neurological Sequelae, and Prognostic Implications

TL;DR

This study finds that Staphylococcus aureus infective endocarditis leads to more neurological complications and higher short-term mortality compared to other causes, though outcomes are similar after surgery.

Contribution

The study provides new insights into the clinical outcomes and neurological risks specific to Staphylococcus aureus infective endocarditis.

Findings

SA-IE patients had significantly higher pre-surgery neurological complications (42.2% vs 22.9%).

Short-term mortality was higher in SA-IE (20.3% vs 12.5%).

Post-surgery neurological events were similar between SA-IE and non-SA-IE patients.

Abstract

Background:Staphylococcus aureus infective endocarditis (SA-IE) is believed to provoke higher rates of complications compared to other organisms that commonly cause IE (non-SA-IE). We believe that Staphylococcus aureus (S. aureus) has a high propensity to cause embolic events and cerebrovascular neurological complications. Methods: We conducted a single-center retrospective analysis, encompassing 529 patients who had undergone valve surgery for IE. Patients were divided according to causative microorganism into SA-IE and non-SA-IE groups. Subsequently, analyses of outcome differences between the two groups were performed, with a focus on neurological complications. Results: In the examined population, 128 (24.2%) had IE mediated by S. aureus. Patients with SA-IE were mostly male (69.3%) but had a higher proportion of females compared to non-SA-IE patients (30.7% vs. 21.8%; p = 0.039) and were significantly younger (61.1 [45.8–69.9] vs. 66.1 [54.3–74.4]; p = 0.002). Patients with SA-IE had comparable comorbidities to patients with non-SA-IE. Neurological complications were much more common in SA-IE (42.2%) compared to non-SA-IE (22.9%); (p < 0.001). Postoperative neurological complications were nearly equal in both groups—SA-IE 5.5% vs 6.2% in non-SA-IE (p = 0.752); 30-day mortality was significantly higher in patients with SA-IE vs. non-SA-IE (20.3% vs 12.5%; p = 0.028). However, the 1-year mortality rate did not differ between groups (29.4% vs. 22.2%; p = 0.121). Conclusions: Patients with SA-IE are subject to a higher incidence of neurological events prior to surgery and almost twice the short-term mortality rate compared to IE caused by other microorganisms. However, no observable discrepancy in the incidence of neurological events was found between SA- and non-SA-IE cases post-surgery.

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