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1.  Echocardiographic Findings Predict In-Hospital and One-Year Mortality in Left-Sided Native Valve Staphylococcus aureus Endocarditis: An Analysis from The International Collaboration on Endocarditis-Prospective Echo Cohort Study 
Circulation. Cardiovascular imaging  2015;8(7):10.1161/CIRCIMAGING.114.003397 e003397.
Staphylococcus (S.) aureus left-sided native valve infective endocarditis (LNVIE) has higher complication and mortality rates compared with endocarditis from other pathogens. Whether echocardiographic variables can predict prognosis in S. aureus LNVIE is unknown.
Methods and Results
Consecutive patients with LNVIE, enrolled between January 2000 and September 2006, in the International Collaboration on Endocarditis were identified. Subjects without S. aureus IE were matched to those with S. aureus IE by the propensity of having S. aureus. Survival differences were determined using log-rank significance tests. Independent echocardiographic predictors of mortality were identified using Cox-proportional hazards models that included inverse probability of treatment weighting and surgery as a time-dependent covariate. Of 727 subjects with LNVIE and 1-year follow-up, 202 had S. aureus IE. One-year survival rates were significantly lower for patients with S. aureus IE overall (57% S. aureus IE vs. 80% non-S. aureus IE, p<0.001) and in the propensity-matched cohort (59% S. aureus IE vs. 68% non-S. aureus IE, p<0.05). Intracardiac abscess (HR 2.93; 95%CI 1.52–5.40, p<0.001) and left ventricular ejection fraction (LVEF)<40% (OR 3.01; 95%CI 1.35–6.04, p=0.004) were the only independent echocardiographic predictors of in-hospital mortality in S. aureus LNVIE. Valve perforation (HR 2.16; 95% CI 1.21–3.68, p=0.006) and intracardiac abscess (HR 2.25; 95%CI 1.26–3.78, p=0.004) were the only independent predictors of one-year mortality.
S. aureus is an independent predictor of one-year mortality in subjects with LNVIE. In S. aureus LNVIE, intracardiac abscess and LVEF<40% independently predicted in-hospital mortality and intracardiac abscess and perforation independently predicted one-year mortality.
PMCID: PMC4503384  PMID: 26162783
endocarditis; echocardiography; valve; risk factor; survival analysis; infective endocarditis
2.  Prevalence of infective endocarditis in patients with Staphylococcus aureus bacteraemia: the value of screening with echocardiography 
Staphylococcus aureus infective endocarditis (IE) is a critical medical condition associated with a high morbidity and mortality. In the present study, we prospectively evaluated the importance of screening with echocardiography in an unselected S. aureus bacteraemia (SAB) population.
Methods and results
From 1 January 2009 to 31 August 2010, a total of 244 patients with SAB at six Danish hospitals underwent screening echocardiography. The inclusion rate was 73% of all eligible patients (n= 336), and 53 of the 244 included patients (22%; 95% CI: 17–27%) were diagnosed with definite IE. In patients with native heart valves the prevalence was 19% (95% CI: 14–25%) compared with 38% (95% CI: 20–55%) in patients with prosthetic heart valves and/or cardiac rhythm management devices (P= 0.02). No difference was found between Main Regional Hospitals and Tertiary Cardiac Hospitals, 20 vs. 23%, respectively (NS). The prevalence of IE in high-risk patients with one or more predisposing condition or clinical evidence of IE were significantly higher compared with low-risk patients with no additional risk factors (38 vs. 5%; P < 0.001). IE was associated with a higher 6 months mortality, 14(26%) vs. 28(15%) in SAB patients without IE, respectively (P < 0.05).
SAB patients carry a high risk for development of IE, which is associated with a worse prognosis compared with uncomplicated SAB. The presenting symptoms and clinical findings associated with IE are often non-specific and echocardiography should always be considered as part of the initial evaluation of SAB patients.
PMCID: PMC3117467  PMID: 21685200
Infective endocarditis; Echocardiography; Staphylococcus aureus; Screening
3.  Future challenges and treatment of Staphylococcus aureus bacteremia with emphasis on MRSA 
Future microbiology  2011;6(1):43-56.
Staphylococcus aureus bacteremia (SAB) is an urgent medical problem due to its growing frequency and its poor associated outcome. As healthcare delivery increasingly involves invasive procedures and implantable devices, the number of patients at risk for SAB and its complications is likely to grow. Compounding this problem is the growing prevalence of methicillin resistant S. aureus (MRSA) and the dwindling efficacy of vancomycin, long the treatment of choice for this pathogen. Despite the recent availability of several new antibiotics for S. aureus, new strategies for treatment and prevention are required for this serious, common cause of human infection.
PMCID: PMC3031962  PMID: 21162635
Staphylococcus aureus; bacteremia; MRSA; epidemiology; infective endocarditis; treatment

Results 1-3 (3)