Current trends of infective endocarditis caused by Staphylococcus aureus and coagulase negative staphylococci in Greece: results from the Hellenic Endocarditis Study Group, 2000–2004

Abstract number: 1733_969

Giannitsioti E., Antoniadou A., Tsiodras S., Skiadas I., Kanavos K., Triantafyllidi H., Giamarellou on behalf of the Hellenic Endocarditis Study Group H.

Objectives: Infective endocarditis (IE) of staphylococcal aetiology emerges worldwide. Current trends of Staphylococcus aureus IE and coagulase negative staphylococci (CNS) IE were investigated through a large epidemiological survey in Greece.

Patients and Methods: Cases of IE fulfilling the Duke criteria were prospectively recorded in 20 general hospitals at the metropolitan area of Athens from 2000–2004. Both S. aureus and CNS cases of IE were assessed regarding epidemiological issues, and outcome. Chi-square test was used for statistical analysis of categorical variables.

Results: From 195 eligible IE cases, 34 (17.4%) and 19 (9.7%) were caused by S. aureus and CNS respectively. S. aureus IE more often than other causative agents of IE affected patients younger that 40 years old (11/34, p < 0.001), intravenous drug users-IVDU (9/34, p < 0.001) and the tricuspid valve (8/34 p < 0.001. Cardiac predisposition for S. aureus IE was not frequent (5/34, p = 0.005). CNS (11/19, p < 0.001) but not S. aureus (5/34, p = 0.3) IE cases were nosocomially acquired. CNS more often affected aortic valve and patients with prosthetic valve IE (p < 0.001). Mortality at day 28 was higher for CNS (10/19, p = 0.009) than for S. aureus (11/34, p = 0.2). Surgical rates for CNS were lower than for other IE causes (1/16 vs 52/118, p = 0.04). On the contrary, there was no difference in rates of surgery for S. aureus IE (10/24, p = 1.0).

Conclusion: CNS IE was mostly hospital acquired, affecting prosthetic valves and presenting higher mortality rates. S. aureus IE affected native valves in younger patients and IVDU. These trends generate the need for a continuous investigation of risk factors of acquisition of nosocomial and community acquired staphylococcal IE in Greece in order to better apply prevention and treatment.