UMR CNRS 6249 Chrono-Environnement, Université de Franche-Comté, France; Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Régional Universitaire, Hôpital Jean Minjoz, Boulevard Fleming, Besançon cedex, France; Université de Lorraine, Université Paris Descartes, Apemac, Nancy, France; INSERM, CIC-EC, CIE6, Nancy, France; CHUNancy, Pôle S2R, Epidémiologie et Evaluation Cliniques, Nancy, France; Department of Medicine, Duke University Medical Center, Durham, NC, United States; Department of Cardiothoracic Sciences, University of Naples S.U.N., Monaldi Hospital, Italy; Servei de Malalties Infeccioses, Hospital Universitari Vall D'Hebron, Universitat Autònoma de Barcelona, Spain; Fourth Department of Internal Medicine, Attikon University, General Hospital, Athens, Greece; Department of Microbiology, Mater Misericordiae University Hospital, Dublin, Ireland; Department of Infectious Diseases, Medical Centre Ljubljana, Slovenia; Hospital Clinic, IDIBAPS, University of Barcelona, Madrid, Spain; Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand; Maladies Infectieuses et Réanimation Médicale, Pontchaillou University Hospital, Rennes, France; Départment de Cardiologie, Hôpital Universitaire Sud, Amiens, France; Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud, EA 4537, Pointe-à-Pitre, Guadeloupe; Service de Maladies Infectieuses et Tropicales, CIC 1424, Centre Hospitalier Universitaire, Pointe-à-Pitre, France; Hospital Italiano, Italy; Instituto Cardiovascular, United States; Hospital Universitario de la Fundaciòn Favaloro, Argentina; Sanatorio de la Trinidad Mitre, Argentina; Alfred Hospital, Argentina; Barwon Health, Argentina; Canberra Hospital, Australia; Flinders Medical Centre, Australia; Royal Melbourne Hospital, Australia; Southern Health, Australia; St George Hospital, Australia; St Vincent's, Australia; Sutherland, United States; University of New South Wales, Australia; Vienna General Hospital, Austria; Ana Neri Hospital, Brazil; Heart Institute (Incor), University of Sao Paulo, Medical School, Brazil; Hospital 9 de Julho, Brazil; Hospital Universitario Clementino Fraga Filho, UFRJ, Brazil; Instituto Dante Pazzanese de Cardiologia, Brazil; Instituto Nacional de Cardiologi, Mexico; University of Manitoba, Canada; Hospital Clínico Pont, Universidad Católica de Chile, Chile; Hospital Clinico, Universidad de Chile, Chile; University Hospital for Infectious Diseases, Chile; Centre for Cardiovascular Surgery and Transplantation, Chile; Cairo University, Medical School, Egypt; CHU Nancy-Brabois, France; Faculté de Médecine de Marseille, France; Hospital Louis Pradel, France; Pontchaillou University, France; South Hospital Amiens, France; University Medical Center of Besançon, France; Universitaetskliniken Bergmannsheil Bochum, Germany; University Essen, Germany; Attikon University, General Hospital, Greece; Evangelismos General Hospital of Athens, Greece; All India Institute of Medical Sciences, India; Medical College Calicut, United States; Mater Hospitals, Australia; Hadassah-Hebrew University, Israel; Tel Aviv University, School of Medicine, Israel; II Università di Napoli, Italy; Maria Vittoria Hospital, Italy; Ospedale di Circolo Varese, Italy; Ospedali Riuniti di Bergamo, Italy; Spedali Civili - Università di Brescia, Italy; American University, Beirut Medical Center, United States; University of Malaya Medical Center, Malaysia; National Heart Institute, United States; Instituto Nacional de Cardiología Ignacio Chávez, Mexico; University of Amsterdam, Netherlands; University of Otago, New Zealand; Middlemore Hospital, New Zealand; Diagnostic Medlab, New Zealand; Wellington Hospital, United Kingdom; North Shore Hospital, New Zealand; ICE Coordinating Center, United States; Victor Babes University of Medicine and Pharmacy, Romania; Learning-Scientific Centre, Medical Centre, Russian Presidential Affairs Government Medical Centre of Russian, Russian Federation; Russian Medical State University, Russian Federation; King Faisal Specialist Hospital, Research Center, Saudi Arabia; National Heart Centre, United States; Medical Center Ljublijana, Slovenia; University of Cape Town, Groote Schuur Hospital, South Africa; Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain; Hospitál de Sabadell, Spain; Hospital General Universitario Gregorio Marañón, Spain; Hospital Universitari Vall D'Hebron, Spain; Hospital Universitario Virgen Del Rocío, Spain; Sahlgrenska Universitetssjukhuset/Östra, Sweden; Khon Kaen University, Thailand; Queen Elizabeth Hospital, United Kingdom; St Thomas' Hospital, United States; Ann Arbor VA Medical Center, United States; Dallas VA Medical Center, United States; Duke University Medical Center, United States; Emory University, United States; Medical University of South Carolina, United States; New York University Medical Center, United States; Summa Health System, United States; University of Alabama at Birmingham, United States; UT-Southwestern Medical Center, United States; Wayne State University, United States; Quintiles, United States
Background. The impact of early valve surgery (EVS) on the outcome of Staphylococcus aureus (SA) prosthetic valve infective endocarditis (PVIE) is unresolved. The objective of this study was to evaluate the association between EVS, performed within the first 60 days of hospitalization, and outcome of SA PVIE within the International Collaboration on Endocarditis-Prospective Cohort Study. Methods. Participants were enrolled between June 2000 and December 2006. Cox proportional hazards modeling that included surgery as a time-dependent covariate and propensity adjustment for likelihood to receive cardiac surgery was used to evaluate the impact of EVS and 1-year all-cause mortality on patients with definite left-sided S. aureus PVIE and no history of injection drug use. Results. EVS was performed in 74 of the 168 (44.3%) patients. One-year mortality was significantly higher among patients with S. aureus PVIE than in patients with non-S. aureus PVIE (48.2% vs 32.9%; P = .003). Staphylococcus aureus PVIE patients who underwent EVS had a significantly lower 1-year mortality rate (33.8% vs 59.1%; P = .001). In multivariate, propensity-adjusted models, EVS was not associated with 1-year mortality (risk ratio, 0.67 [95% confidence interval, .39-1.15]; P = .15). Conclusions. In this prospective, multinational cohort of patients with S. aureus PVIE, EVS was not associated with reduced 1-year mortality. The decision to pursue EVS should be individualized for each patient, based upon infection-specific characteristics rather than solely upon the microbiology of the infection causing PVIE. © The Author 2014.