To the Editor: The global emergence of infective endocarditis (IE) caused by Staphylococcus aureus was reported by Dr Fowler and colleagues.1 Among 1779 patients with IE enrolled between 2000 and 2003 from the United States, Brazil, Australia, New Zealand, Europe, and the Middle East, the most common causative pathogen was S aureus (558 cases, 31.4%). However, in Japan S aureus was still the second most common cause of IE (17.1%) after Streptococcus viridans (31.7%) found in a nationwide surveillance between 2000 and 2001.2 It would therefore be important to know if there was any variation in the prevalence of S aureus IE among the international regions in their study.
In addition, Fowler et al described important characteristics of patients with S aureus IE. Stroke was the most important determinant of mortality by multivariate analysis. Risk of embolization in IE based on the echocardiographic assessment of vegetations has been reported.3 - 4 In general, highly mobile vegetations of more than 10 mm in size on echocardiography carry a high risk of embolization.4 Thus, it would be valuable to have an echocardiographic comparison of vegetations between S aureus IE and non-S aureus IE focusing on their size and mobility. If these high-risk profiles of vegetations are confirmed in S aureus IE, particularly in those persons who subsequently developed embolic complications, serial echocardiographic evaluation may be necessary in the treatment of S aureus IE. However, if the International Collaboration of Endocarditis-Prospective Cohort Study (ICE-PCS) did not find a high-risk profile for vegetations associated with S aureus IE, urgent valve surgery may be appropriate in patients with definite IE whenever blood culture yields S aureus.
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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