RT Journal
A1 Fowler VG, Miro JM, Hoen B, et al
T1 Staphylococcus aureus endocarditis: A consequence of medical progress
JF JAMA
JO JAMA
YR 2005
FD June 22
VO 293
IS 24
SP 3012
OP 3021
DO 10.1001/jama.293.24.3012
UL http://dx.doi.org/10.1001/jama.293.24.3012
AB Context 
                  The global significance of infective endocarditis (IE) caused by Staphylococcus aureus is unknown.Objectives 
                  To document the international emergence of health care–associated S aureus IE and methicillin-resistant S aureus (MRSA) IE and to evaluate regional variation in patients with S aureus IE.Design, Setting, and Participants 
                  Prospective observational cohort study set in 39 medical centers in
16 countries. Participants were a population of 1779 patients with definite
IE as defined by Duke criteria who were enrolled in the International Collaboration
on Endocarditis-Prospective Cohort Study from June 2000 to December 2003.Main Outcome Measure 
                  In-hospital mortality.Results 
                  S aureus was the most common pathogen among
the 1779 cases of definite IE in the International Collaboration on Endocarditis
Prospective-Cohort Study (558 patients, 31.4%). Health care−associated
infection was the most common form of S aureus IE
(218 patients, 39.1%), accounting for 25.9% (Australia/New Zealand) to 54.2%
(Brazil) of cases. Most patients with health care−associated S aureus IE (131 patients, 60.1%) acquired the infection outside of
the hospital. MRSA IE was more common in the United States (37.2%) and Brazil
(37.5%) than in Europe/Middle East (23.7%) and Australia/New Zealand (15.5%, P<.001). Persistent bacteremia was independently associated
with MRSA IE (odds ratio, 6.2; 95% confidence interval, 2.9-13.2). Patients
in the United States were most likely to be hemodialysis dependent, to have
diabetes, to have a presumed intravascular device source, to receive vancomycin,
to be infected with MRSA, and to have persistent bacteremia (P<.001 for all comparisons).Conclusions 
                  S aureus is the leading cause of IE in many
regions of the world. Characteristics of patients with S aureus IE vary significantly by region. Further studies are required
to determine the causes of regional variation.