Staphylococcus aureus endocarditis in community hospitals.

Abstract

We compared 13 cases of Staphylococcus aureus endocarditis from community hospitals to previous series all of which originated from university or tertiary care hospitals. In our experience Staph. aureus was the third leading cause of endocarditis and accounted for 20% of cases. The infection presented as one of three syndromes: native valve endocarditis, prosthetic valve endocarditis and endocarditis in drug addicts. Laboratory data revealed leukocytosis; infiltrates, nodules, congestive heart failure and cardiomegaly were seen on chest x-ray; and echocardiography infrequently detected vegetations. Criteria which favored the diagnosis of endocarditis in staphylococcemic patients were: absence of a primary site of infection, community acquisition of infection, metastatic infectious sequelae and vegetations documented by echocardiography. Treatment requires prolonged intravenous administration of high dose bactericidal antimicrobial agents; commonly nafcillin or oxacillin combined for a variable period with gentamicin. The mortality rate in our series was 23% and complications occurred in 70% of cases.