Staphylococcus aureus Endocarditis

Fowler, Vance G.; Miró, José M.; Hoën, Bruno; Cabell, Christopher H.; Abrutyn, Elías; Rubinstein, Ethan; Corey, G. Ralph; Spelman, Denis; Bradley, Suzanne F.; Baršić, Bruno; Pappas, Paul; Anstrom, Kevin J.; Wray, Dannah; Fortes, Cláudio Querido; Anguera, Ignasi; Athan, Eugene; Jones, Philip; Meer, J.T.M. van der; Elliott, Tom; Levine, Donald P.; Bayer, Arnold S.

doi:10.1001/jama.293.24.3012

Cited by 1,004 publications

(307 citation statements)

References 52 publications

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“…With the exception of intravenous drug users, patients who develop endocarditis often have health care risk factors, such as indwelling lines, history of surgery, or underlying disease, such as diabetes (12). Recent reports suggest that CA-MRSA infectious endocarditis cases could be increasing (11,25), and more than 30% of the CA-MRSA patients described in that report had recent or concurrent skin infections. In this study, 15.4% of CA-MRSA endocarditis patients and 14.8% of USA300 endocarditis patients had concurrent or underlying skin or soft tissue infections, compared to 8.1% of USA100 endocarditis patients.…”

Section: Discussionmentioning

confidence: 97%

Characterization of Methicillin-Resistant Staphylococcus aureus Isolates Collected in 2005 and 2006 from Patients with Invasive Disease: a Population-Based Analysis

et al. 2009

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This study characterizes 1,984 methicillin-resistant Staphylococcus aureus (MRSA) isolates collected in 2005and 2006 from normally sterile sites in patients with invasive MRSA infection. These isolates represent a convenience sample of all invasive MRSA cases reported as part of the Active Bacterial Core surveillance system in eight states in the United States. The majority of isolates were from blood (83.8%), joints (4.1%), and bone (4.2%). Isolates were characterized by pulsed-field gel electrophoresis (PFGE); SCCmec typing; susceptibility to 15 antimicrobial agents; and PCR analysis of staphylococcal enterotoxin A (SEA) to SEH, toxic shock syndrome toxin 1, and Panton-Valentine leukocidin. Thirteen established PFGE types were recognized among these isolates, although USA100 and USA300 predominated, accounting for 53.2% and 31.4% of the isolates, respectively. As expected, isolates from hospital onset cases were predominantly USA100, whereas those from community-associated cases were predominantly USA300.

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Section: Discussionmentioning

confidence: 97%

Characterization of Methicillin-Resistant Staphylococcus aureus Isolates Collected in 2005 and 2006 from Patients with Invasive Disease: a Population-Based Analysis

et al. 2009

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“…These 2 prospective multinational registries collected consecutive cases of definite IE by modified Duke criteria,10 with prespecified definitions of variables, as described previously 3, 11. For the derivation cohort, the ICE‐PCS registry included 5676 patients from 64 centers in 28 countries who were hospitalized between June 2000 and December 2006 for definite IE and who had vital status follow‐up information available at 1 year after discharge.…”

Section: Methodsmentioning

confidence: 99%

“…Despite improvements in diagnostic testing, antimicrobial treatment, and surgical intervention, changes in the epidemiology of IE, including the rise of health care–associated infection and Staphylococcus aureus as a virulent causative organism,2, 3 increase the risk of complications and death in the acute phase of IE. Furthermore, survival after hospital discharge may be reduced by late complications and comorbid conditions 4, 5…”

Section: Introductionmentioning

confidence: 99%

Validated Risk Score for Predicting 6‐Month Mortality in Infective Endocarditis

Park

Peterson

Skoutelis

et al. 2016

JAHA

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111

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BackgroundHost 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 ResultsUsing 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.ConclusionsSix‐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.

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“…taphylococcus aureus is a leading cause of bacterial infections (1)(2)(3)(4), including skin and soft tissue infections (5), pneumonia (6), bacteremia (7), endocarditis (8)(9)(10), and bone and joint infections (11). The risk of invasive S. aureus infections is significantly higher among certain subgroups, including hemodialysisdependent patients and postoperative patients (12)(13)(14).These high-risk subpopulations are potential candidates for novel forms of prevention or treatment against invasive S. aureus infections.…”

mentioning

confidence: 99%

Characterization of Alpha-Toxin hla Gene Variants, Alpha-Toxin Expression Levels, and Levels of Antibody to Alpha-Toxin in Hemodialysis and Postsurgical Patients with Staphylococcus aureus Bacteremia

Sharma-Kuinkel

Wu²,

Tabor³

et al. 2015

J Clin Microbiol

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c Alpha-toxin is a major Staphylococcus aureus virulence factor. This study evaluated potential relationships between in vitro alpha-toxin expression of S. aureus bloodstream isolates, anti-alpha-toxin antibody in serum of patients with S. aureus bacteremia (SAB), and clinical outcomes in 100 hemodialysis and 100 postsurgical SAB patients. Isolates underwent spa typing and hla sequencing. Serum anti-alpha-toxin IgG and neutralizing antibody levels were measured by using an enzyme-linked immunosorbent assay and a red blood cell (RBC)-based hemolysis neutralization assay. Neutralization of alpha-toxin by an anti-alpha-toxin monoclonal antibody (MAb MEDI4893) was tested in an RBC-based lysis assay. Most isolates encoded hla (197/200; 98.5%) and expressed alpha-toxin (173/200; 86.5%). In vitro alpha-toxin levels were inversely associated with survival (cure, 2.19 g/ml, versus failure, 1.09 g/ml; P < 0.01). Both neutralizing (hemodialysis, 1.26 IU/ml, versus postsurgical, 0.95; P < 0.05) and IgG (hemodialysis, 1.94 IU/ml, versus postsurgical, 1.27; P < 0.05) antibody levels were higher in the hemodialysis population. Antibody levels were also significantly higher in patients infected with alpha-toxin-expressing S. aureus isolates (P < 0.05). Levels of both neutralizing antibodies and IgG were similar among patients who were cured and those not cured (failures). Sequence analysis of hla revealed 12 distinct hla genotypes, and all genotypic variants were susceptible to a neutralizing monoclonal antibody in clinical development (MEDI4893). These data demonstrate that alpha-toxin is highly conserved in clinical S. aureus isolates. Higher in vitro alpha-toxin levels were associated with a positive clinical outcome. Although patients infected with alpha-toxin-producing S. aureus exhibited higher anti-alpha-toxin antibody levels, these levels were not associated with a better clinical outcome in this study. Staphylococcus aureus is a leading cause of bacterial infections (1-4), including skin and soft tissue infections (5), pneumonia (6), bacteremia (7), endocarditis (8-10), and bone and joint infections (11). The risk of invasive S. aureus infections is significantly higher among certain subgroups, including hemodialysisdependent patients and postoperative patients (12-14).These high-risk subpopulations are potential candidates for novel forms of prevention or treatment against invasive S. aureus infections.Alpha-toxin, a ␤-barrel pore-forming exotoxin encoded by hla (15, 16), is a key virulence factor produced by most S. aureus isolates (17, 18). It binds to ADAM10 (the A disintegrin and metalloproteinase domain-containing protein 10) on target cell membranes and then heptamerizes to generate a transmembrane pore, resulting in cell lysis (19). Hyperproduction of alpha-toxin is associated with enhanced virulence in strains of both epidemic (USA300 and USA500) and endemic (ST93) community-associated methicillin-resistant S. aureus (CA-MRSA) isolates (20,21). Studies with a number of animal models have also suggested that al...

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Staphylococcus aureus Endocarditis

Cited by 1,004 publications

References 52 publications

Characterization of Methicillin-Resistant Staphylococcus aureus Isolates Collected in 2005 and 2006 from Patients with Invasive Disease: a Population-Based Analysis

Characterization of Methicillin-Resistant Staphylococcus aureus Isolates Collected in 2005 and 2006 from Patients with Invasive Disease: a Population-Based Analysis

Validated Risk Score for Predicting 6‐Month Mortality in Infective Endocarditis

Characterization of Alpha-Toxin hla Gene Variants, Alpha-Toxin Expression Levels, and Levels of Antibody to Alpha-Toxin in Hemodialysis and Postsurgical Patients with Staphylococcus aureus Bacteremia

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