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1.  Impact of Early Valve Surgery on Outcome of Staphylococcus aureus Prosthetic Valve Infective Endocarditis: Analysis in the International Collaboration of Endocarditis–Prospective Cohort Study 
Chirouze, Catherine | Alla, François | Fowler, Vance G. | Sexton, Daniel J. | Corey, G. Ralph | Chu, Vivian H. | Wang, Andrew | Erpelding, Marie-Line | Durante-Mangoni, Emanuele | Fernández-Hidalgo, Nuria | Giannitsioti, Efthymia | Hannan, Margaret M. | Lejko-Zupanc, Tatjana | Miró, José M. | Muñoz, Patricia | Murdoch, David R. | Tattevin, Pierre | Tribouilloy, Christophe | Hoen, Bruno | Clara, Liliana | Sanchez, Marisa | Nacinovich, Francisco | Oses, Pablo Fernandez | Ronderos, Ricardo | Sucari, Adriana | Thierer, Jorge | Casabé, José | Cortes, Claudia | Altclas, Javier | Kogan, Silvia | Spelman, Denis | Athan, Eugene | Harris, Owen | Kennedy, Karina | Tan, Ren | Gordon, David | Papanicolas, Lito | Eisen, Damon | Grigg, Leeanne | Street, Alan | Korman, Tony | Kotsanas, Despina | Dever, Robyn | Jones, Phillip | Konecny, Pam | Lawrence, Richard | Rees, David | Ryan, Suzanne | Feneley, Michael P. | Harkness, John | Jones, Phillip | Ryan, Suzanne | Jones, Phillip | Ryan, Suzanne | Jones, Phillip | Post, Jeffrey | Reinbott, Porl | Ryan, Suzanne | Gattringer, Rainer | Wiesbauer, Franz | Andrade, Adriana Ribas | de Brito, Ana Cláudia Passos | Guimarães, Armenio Costa | Grinberg, Max | Mansur, Alfredo José | Siciliano, Rinaldo Focaccia | Strabelli, Tania Mara Varejao | Vieira, Marcelo Luiz Campos | de Medeiros Tranchesi, Regina Aparecida | Paiva, Marcelo Goulart | Fortes, Claudio Querido | de Oliveira Ramos, Auristela | Ferraiuoli, Giovanna | Golebiovski, Wilma | Lamas, Cristiane | Santos, Marisa | Weksler, Clara | Karlowsky, James A. | Keynan, Yoav | Morris, Andrew M. | Rubinstein, Ethan | Jones, Sandra Braun | Garcia, Patricia | Cereceda, M | Fica, Alberto | Mella, Rodrigo Montagna | Barsic, Bruno | Bukovski, Suzana | Krajinovic, Vladimir | Pangercic, Ana | Rudez, Igor | Vincelj, Josip | Freiberger, Tomas | Pol, Jiri | Zaloudikova, Barbora | Ashour, Zainab | El Kholy, Amani | Mishaal, Marwa | Rizk, Hussien | Aissa, Neijla | Alauzet, Corentine | Alla, Francois | Campagnac, Catherine | Doco-Lecompte, Thanh | Selton-Suty, Christine | Casalta, Jean-Paul | Fournier, Pierre-Edouard | Habib, Gilbert | Raoult, Didier | Thuny, Franck | Delahaye, François | Delahaye, Armelle | Vandenesch, Francois | Donal, Erwan | Donnio, Pierre Yves | Michelet, Christian | Revest, Matthieu | Tattevin, Pierre | Violette, Jérémie | Chevalier, Florent | Jeu, Antoine | Sorel, Claire | Tribouilloy, Christophe | Bernard, Yvette | Chirouze, Catherine | Hoen, Bruno | Leroy, Joel | Plesiat, Patrick | Naber, Christoph | Neuerburg, Carl | Mazaheri, Bahram | Naber, Christoph | Neuerburg, Carl | Athanasia, Sofia | Giannitsioti, Efthymia | Mylona, Elena | Paniara, Olga | Papanicolaou, Konstantinos | Pyros, John | Skoutelis, Athanasios | Sharma, Gautam | Francis, Johnson | Nair, Lathi | Thomas, Vinod | Venugopal, Krishnan | Hannan, Margaret | Hurley, John | Gilon, Dan | Israel, Sarah | Korem, Maya | Strahilevitz, Jacob | Rubinstein, Ethan | Strahilevitz, Jacob | Casillo, Roberta | Cuccurullo, Susanna | Dialetto, Giovanni | Durante-Mangoni, Emanuele | Irene, Mattucci | Ragone, Enrico | Tripodi, Marie Françoise | Utili, Riccardo | Cecchi, Enrico | De Rosa, Francesco | Forno, Davide | Imazio, Massimo | Trinchero, Rita | Tebini, Alessandro | Grossi, Paolo | Lattanzio, Mariangela | Toniolo, Antonio | Goglio, Antonio | Raglio, Annibale | Ravasio, Veronica | Rizzi, Marco | Suter, Fredy | Carosi, Giampiero | Magri, Silvia | Signorini, Liana | Baban, Tania | Kanafani, Zeina | Kanj, Souha S. | Yasmine, Mohamad | Abidin, Imran | Tamin, Syahidah Syed | Martínez, Eduardo Rivera | Soto Nieto, Gabriel Israel | van der Meer, Jan T.M. | Chambers, Stephen | Holland, David | Morris, Arthur | Raymond, Nigel | Read, Kerry | Murdoch, David R. | Dragulescu, Stefan | Ionac, Adina | Mornos, Cristian | Butkevich, O.M. | Chipigina, Natalia | Kirill, Ozerecky | Vadim, Kulichenko | Vinogradova, Tatiana | Edathodu, Jameela | Halim, Magid | Lum, Luh-Nah | Tan, Ru-San | Lejko-Zupanc, Tatjana | Logar, Mateja | Mueller-Premru, Manica | Commerford, Patrick | Commerford, Anita | Deetlefs, Eduan | Hansa, Cass | Ntsekhe, Mpiko | Almela, Manuel | Armero, Yolanda | Azqueta, Manuel | Castañeda, Ximena | Cervera, Carlos | del Rio, Ana | Falces, Carlos | Garcia-de-la-Maria, Cristina | Fita, Guillermina | Gatell, Jose M. | Marco, Francesc | Mestres, Carlos A. | Miró, José M. | Moreno, Asuncion | Ninot, Salvador | Paré, Carlos | Pericas, Joan | Ramirez, Jose | Rovira, Irene | Sitges, Marta | Anguera, Ignasi | Font, Bernat | Guma, Joan Raimon | Bermejo, Javier | Bouza, Emilio | Fernández, Miguel Angel Garcia | Gonzalez-Ramallo, Victor | Marín, Mercedes | Muñoz, Patricia | Pedromingo, Miguel | Roda, Jorge | Rodríguez-Créixems, Marta | Solis, Jorge | Almirante, Benito | Fernandez-Hidalgo, Nuria | Tornos, Pilar | de Alarcón, Arístides | Parra, Ricardo | Alestig, Eric | Johansson, Magnus | Olaison, Lars | Snygg-Martin, Ulrika | Pachirat, Orathai | Pachirat, Pimchitra | Pussadhamma, Burabha | Senthong, Vichai | Casey, Anna | Elliott, Tom | Lambert, Peter | Watkin, Richard | Eyton, Christina | Klein, John L. | Bradley, Suzanne | Kauffman, Carol | Bedimo, Roger | Chu, Vivian H. | Corey, G. Ralph | Crowley, Anna Lisa | Douglas, Pamela | Drew, Laura | Fowler, Vance G. | Holland, Thomas | Lalani, Tahaniyat | Mudrick, Daniel | Samad, Zaniab | Sexton, Daniel | Stryjewski, Martin | Wang, Andrew | Woods, Christopher W. | Lerakis, Stamatios | Cantey, Robert | Steed, Lisa | Wray, Dannah | Dickerman, Stuart A. | Bonilla, Hector | DiPersio, Joseph | Salstrom, Sara-Jane | Baddley, John | Patel, Mukesh | Peterson, Gail | Stancoven, Amy | Afonso, Luis | Kulman, Theresa | Levine, Donald | Rybak, Michael | Cabell, Christopher H. | Baloch, Khaula | Chu, Vivian H. | Corey, G. Ralph | Dixon, Christy C. | Fowler, Vance G. | Harding, Tina | Jones-Richmond, Marian | Pappas, Paul | Park, Lawrence P. | Redick, Thomas | Stafford, Judy | Anstrom, Kevin | Athan, Eugene | Bayer, Arnold S. | Cabell, Christopher H. | Chu, Vivian H. | Corey, G. Ralph | Fowler, Vance G. | Hoen, Bruno | Karchmer, A. W. | Miró, José M. | Murdoch, David R. | Sexton, Daniel J. | Wang, Andrew | Bayer, Arnold S. | Cabell, Christopher H. | Chu, Vivian | Corey, G. Ralph | Durack, David T. | Eykyn, Susannah | Fowler, Vance G. | Hoen, Bruno | Miró, José M. | Moreillon, Phillipe | Olaison, Lars | Raoult, Didier | Rubinstein, Ethan | Sexton, Daniel J.
Using appropriate analytical methods to examine data from the International Collaboration on Endocarditis–Prospective Cohort Study, we found that early valve surgery was not associated with reduced 1-year mortality in Staphylococcus aureus prosthetic valve infective endocarditis.
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.
doi:10.1093/cid/ciu871
PMCID: PMC4366581  PMID: 25389255
endocarditis; prosthetic valve; surgery; 1-year mortality
2.  Validated Risk Score for Predicting 6‐Month Mortality in Infective Endocarditis 
Park, Lawrence P. | Chu, Vivian H. | Peterson, Gail | Skoutelis, Athanasios | Lejko‐Zupa, Tatjana | Bouza, Emilio | Tattevin, Pierre | Habib, Gilbert | Tan, Ren | Gonzalez, Javier | Altclas, Javier | Edathodu, Jameela | Fortes, Claudio Querido | Siciliano, Rinaldo Focaccia | Pachirat, Orathai | Kanj, Souha | Wang, Andrew | Clara, Liliana | Sanchez, Marisa | Casabé, José | Cortes, Claudia | Nacinovich, Francisco | Fernandez Oses, Pablo | Ronderos, Ricardo | Sucari, Adriana | Thierer, Jorge | Kogan, Silvia | Spelman, Denis | Athan, Eugene | Harris, Owen | Kennedy, Karina | Gordon, David | Papanicolas, Lito | Korman, Tony | Kotsanas, Despina | Dever, Robyn | Jones, Phillip | Konecny, Pam | Lawrence, Richard | Rees, David | Ryan, Suzanne | Feneley, Michael P. | Harkness, John | Jones, Phillip | Ryan, Suzanne | Jones, Phillip | Ryan, Suzanne | Jones, Phillip | Post, Jeffrey | Reinbott, Porl | Ryan, Suzanne | Gattringer, Rainer | Wiesbauer, Franz | Andrade, Adriana Ribas | de Brito, Ana Cláudia Passos | Guimarães, Armenio Costa | Grinberg, Max | Mansur, Alfredo José | Strabelli, Tania Mara Varejao | Vieira, Marcelo Luiz Campos | de Medeiros Tranchesi, Regina Aparecida | Paiva, Marcelo Goulart | de Oliveira Ramos, Auristela | Weksler, Clara | Ferraiuoli, Giovanna | Golebiovski, Wilma | Lamas, Cristiane | Karlowsky, James A. | Keynan, Yoav | Morris, Andrew M. | Rubinstein, Ethan | Jones, Sandra Braun | Garcia, Patricia | Fica, Alberto | Mella, Rodrigo Montagna | Fernandez, Ricardo | Franco, Liliana | Jaramillo, Astrid Natalia | Barsic, Bruno | Bukovski, Suzana | Krajinovic, Vladimir | Pangercic, Ana | Rudez, Igor | Vincelj, Josip | Freiberger, Tomas | Pol, Jiri | Zaloudikova, Barbora | Ashour, Zainab | El Kholy, Amani | Mishaal, Marwa | Osama, Dina | Rizk, Hussien | Aissa, Neijla | Alauzet, Corentine | Alla, Francois | Campagnac, Catherine | Doco‐Lecompte, Thanh | Selton‐Suty, Christine | Casalta, Jean‐Paul | Fournier, Pierre‐Edouard | Raoult, Didier | Thuny, Franck | Delahaye, Francois | Delahaye, Armelle | Vandenesch, Francois | Donal, Erwan | Donnio, Pierre Yves | Flecher, Erwan | Michelet, Christian | Revest, Matthieu | Chevalier, Florent | Jeu, Antoine | Rémadi, Jean Paul | Rusinaru, Dan | Tribouilloy, Christophe | Bernard, Yvette | Chirouze, Catherine | Hoen, Bruno | Leroy, Joel | Plesiat, Patrick | Naber, Christoph | Neuerburg, Carl | Mazaheri, Bahram | Naber, Christoph | Neuerburg, Carl | Athanasia, Sophia | Deliolanis, Ioannis | Giamarellou, Helen | Thomas, Tsaganos | Giannitsioti, Efthymia | Mylona, Elena | Paniara, Olga | Papanicolaou, Konstantinos | Pyros, John | Mylona, Elena | Paniara, Olga | Papanikolaou, Konstantinos | Pyros, John | Sharma, Gautam | Francis, Johnson | Nair, Lathi | Thomas, Vinod | Venugopal, Krishnan | Hannan, Margaret M. | Hurley, John P. | Cahan, Amos | Gilon, Dan | Israel, Sarah | Korem, Maya | Strahilevitz, Jacob | Rubinstein, Ethan | Strahilevitz, Jacob | Durante‐Mangoni, Emanuele | Mattucci, Irene | Pinto, Daniela | Agrusta, Federica | Senese, Alessandra | Ragone, Enrico | Utili, Riccardo | Cecchi, Enrico | De Rosa, Francesco | Forno, Davide | Imazio, Massimo | Trinchero, Rita | Grossi, Paolo | Lattanzio, Mariangela | Toniolo, Antonio | Goglio, Antonio | Raglio, Annibale | Ravasio, Veronica | Rizzi, Marco | Suter, Fredy | Carosi, Giampiero | Magri, Silvia | Signorini, Liana | Kanafani, Zeina | Kanj, Souha S. | Sharif‐Yakan, Ahmad | Abidin, Imran | Tamin, Syahidah Syed | Martínez, Eduardo Rivera | Soto Nieto, Gabriel Israel | van der Meer, Jan T.M. | Chambers, Stephen | Holland, David | Morris, Arthur | Raymond, Nigel | Read, Kerry | Murdoch, David R. | Dragulescu, Stefan | Ionac, Adina | Mornos, Cristian | Butkevich, O.M. | Chipigina, Natalia | Kirill, Ozerecky | Vadim, Kulichenko | Vinogradova, Tatiana | Halim, Magid | Liew, Yee‐Yun | Tan, Ru‐San | Logar, Mateja | Mueller‐Premru, Manica | Commerford, Patrick | Commerford, Anita | Deetlefs, Eduan | Hansa, Cass | Ntsekhe, Mpiko | Almela, Manuel | Armero, Yolanda | Azqueta, Manuel | Castañeda, Ximena | Cervera, Carlos | Falces, Carlos | Garcia‐de‐la‐Maria, Cristina | Fita, Guillermina | Gatell, Jose M. | Heras, Magda | Llopis, Jaime | Marco, Francesc | Mestres, Carlos A. | Miró, José M. | Moreno, Asuncion | Ninot, Salvador | Paré, Carlos | Pericas, Juan M. | Ramirez, Jose | Rovira, Irene | Sitges, Marta | Anguera, Ignasi | Font, Bernat | Guma, Joan Raimon | Bermejo, Javier | Garcia Fernández, Miguel Angel | Gonzalez‐Ramallo, Victor | Marín, Mercedes | Muñoz, Patricia | Pedromingo, Miguel | Roda, Jorge | Rodríguez‐Créixems, Marta | Solis, Jorge | Almirante, Benito | Fernandez‐Hidalgo, Nuria | Tornos, Pilar | de Alarcón, Arístides | Parra, Ricardo | Alestig, Eric | Johansson, Magnus | Olaison, Lars | Snygg‐Martin, Ulrika | Pachirat, Pimchitra | Pussadhamma, Burabha | Senthong, Vichai | Casey, Anna | Elliott, Tom | Lambert, Peter | Watkin, Richard | Eyton, Christina | Klein, John L. | Bradley, Suzanne | Kauffman, Carol | Bedimo, Roger | Corey, G. Ralph | Crowley, Anna Lisa | Douglas, Pamela | Drew, Laura | Fowler, Vance G. | Holland, Thomas | Lalani, Tahaniyat | Mudrick, Daniel | Samad, Zaniab | Sexton, Daniel | Stryjewski, Martin | Woods, Christopher W. | Lerakis, Stamatios | Cantey, Robert | Steed, Lisa | Wray, Dannah | Dickerman, Stuart A. | Bonilla, Hector | DiPersio, Joseph | Salstrom, Sara‐Jane | Baddley, John | Patel, Mukesh | Stancoven, Amy | Levine, Donald | Riddle, Jonathan | Rybak, Michael | Cabell, Christopher H. | Baloch, Khaula | Corey, G. Ralph | Dixon, Christy C. | Fowler, Vance G. | Harding, Tina | Jones‐Richmond, Marian | Sanderford, Bob | Sanderford, Bob | Stafford, Judy | Stafford, Judy | Anstrom, Kevin | Athan, Eugene | Bayer, Arnold S. | Cabell, Christopher H. | Corey, G. Ralph | Fowler, Vance G. | Hoen, Bruno | Karchmer, A. W. | Miró, José M. | Murdoch, David R. | Sexton, Daniel J. | Bayer, Arnold S. | Cabell, Christopher H. | Chu, Vivian | Corey, G. Ralph | Durack, David T. | Eykyn, Susannah | Fowler, Vance G. | Hoen, Bruno | Miró, José M. | Moreillon, Phillipe | Olaison, Lars | Raoult, Didier | Rubinstein, Ethan | Sexton, Daniel J.
Background
Host factors and complications have been associated with higher mortality in infective endocarditis (IE). We sought to develop and validate a model of clinical characteristics to predict 6‐month mortality in IE.
Methods and Results
Using a large multinational prospective registry of definite IE (International Collaboration on Endocarditis [ICE]–Prospective Cohort Study [PCS], 2000–2006, n=4049), a model to predict 6‐month survival was developed by Cox proportional hazards modeling with inverse probability weighting for surgery treatment and was internally validated by the bootstrapping method. This model was externally validated in an independent prospective registry (ICE‐PLUS, 2008–2012, n=1197). The 6‐month mortality was 971 of 4049 (24.0%) in the ICE‐PCS cohort and 342 of 1197 (28.6%) in the ICE‐PLUS cohort. Surgery during the index hospitalization was performed in 48.1% and 54.0% of the cohorts, respectively. In the derivation model, variables related to host factors (age, dialysis), IE characteristics (prosthetic or nosocomial IE, causative organism, left‐sided valve vegetation), and IE complications (severe heart failure, stroke, paravalvular complication, and persistent bacteremia) were independently associated with 6‐month mortality, and surgery was associated with a lower risk of mortality (Harrell's C statistic 0.715). In the validation model, these variables had similar hazard ratios (Harrell's C statistic 0.682), with a similar, independent benefit of surgery (hazard ratio 0.74, 95% CI 0.62–0.89). A simplified risk model was developed by weight adjustment of these variables.
Conclusions
Six‐month mortality after IE is ≈25% and is predicted by host factors, IE characteristics, and IE complications. Surgery during the index hospitalization is associated with lower mortality but is performed less frequently in the highest risk patients. A simplified risk model may be used to identify specific risk subgroups in IE.
doi:10.1161/JAHA.115.003016
PMCID: PMC4859286  PMID: 27091179
infection; mortality; prognosis; surgery; valves; Infectious Endocarditis; Valvular Heart Disease; Mortality/Survival; Clinical Studies
3.  Heterogeneous Vancomycin-Intermediate Susceptibility Phenotype in Bloodstream Methicillin-Resistant Staphylococcus aureus Isolates from an International Cohort of Patients with Infective Endocarditis: Prevalence, Genotype, and Clinical Significance 
The Journal of infectious diseases  2009;200(9):1355-1366.
Background
The significance of heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA) is unknown. Using a multinational collection of isolates from methicillin-resistant S. aureus (MRSA) infective endocarditis (IE), we characterized IE patients with and without hVISA, and genotyped the infecting strains.
Methods
MRSA bloodstream isolates from 65 patients with definite IE from 8 countries underwent PCR for 31 virulence genes, pulsed-field gel electrophoresis, and multilocus sequence typing. hVISA was defined using population analysis profiling (PAP).
Results
Nineteen (29.2%) of 65 MRSA IE isolates exhibited hVISA by PAP. Isolates from Oceania and Europe were more likely to exhibit hVISA than isolates from the United States (77.8% vs. 35.0% vs. 13.9%; P < .001). The prevalence of hVISA was higher among isolates with a vancomycin minimum inhibitory concentration of 2 mg/L (P = .026). hVISA-infected patients were more likely to have persistent bacteremia (68.4% vs. 37.0%; P = .029) and heart failure (47.4% vs. 19.6%; P = .033). Mortality of hVISA- and non-hVISA-infected patients did not differ (42.1% vs. 34.8%, P = .586). hVISA and non-hVISA isolates were genotypically similar.
Conclusions
In these analyses, hVISA occurred in over one-quarter of MRSA IE isolates, was associated with certain IE complications, and varied in frequency by geographic region.
doi:10.1086/606027
PMCID: PMC3600359  PMID: 19811099
hVISA; Methicillin-resistant Staphylococcus aureus; endocarditis; genotype
4.  Methicillin-Susceptible Staphylococcus aureus Endocarditis Isolates Are Associated With Clonal Complex 30 Genotype and a Distinct Repertoire of Enterotoxins and Adhesins 
The Journal of Infectious Diseases  2011;204(5):704-713.
Background. Using multinational collections of methicillin-susceptible Staphylococcus aureus (MSSA) isolates from infective endocarditis (IE) and soft tissue infections (STIs), we sought to (1) validate the finding that S. aureus in clonal complex (CC) 30 is associated with hematogenous complications and (2) test the hypothesis that specific genetic characteristics in S. aureus are associated with infection severity.
Methods. IE and STI isolates from 2 cohorts were frequency matched by geographic origin. Isolates underwent spa typing to infer CC and multiplex polymerase chain reaction for presence of virulence genes.
Results. 114 isolate pairs were genotyped. IE isolates were more likely to be CC30 (19.5% vs 6.2%; P = .005) and to contain 3 adhesins (clfB, cna, map/eap; P < .0001 for all) and 5 enterotoxins (tst, sea, sed, see, and sei; P ≤ .005 for all). CC30 isolates were more likely to contain cna, tst, sea, see, seg, and chp (P < .05 for all).
Conclusions. MSSA IE isolates were significantly more likely to be CC30 and to possess a distinct repertoire of virulence genes than MSSA STI isolates from the same region. The genetic basis of this association requires further study.
doi:10.1093/infdis/jir389
PMCID: PMC3156104  PMID: 21844296
5.  Genotypic Diversity of Coagulase-Negative Staphylococci Causing Endocarditis: a Global Perspective▿  
Journal of Clinical Microbiology  2008;46(5):1780-1784.
Coagulase-negative staphylococci (CNS) are important causes of infective endocarditis (IE), but their microbiological profiles are poorly described. We performed DNA target sequencing and susceptibility testing for 91 patients with definite CNS IE who were identified from the International Collaboration on Endocarditis—Microbiology, a large, multicenter, multinational consortium. A hierarchy of gene sequences demonstrated great genetic diversity within CNS from patients with definite endocarditis that represented diverse geographic regions. In particular, rpoB sequence data demonstrated unique genetic signatures with the potential to serve as an important tool for global surveillance.
doi:10.1128/JCM.02405-07
PMCID: PMC2395089  PMID: 18367572

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