Surgery in Staphylococcus aureus Infective Endocarditis: Clinical Outcomes, Neurological Sequelae, and Prognostic Implications

Abstract

Background:Staphylococcus aureus infective endocarditis (SA-IE) is believed to provoke higher rates of complications compared to other organisms that commonly cause IE (non-SA-IE). We believe that Staphylococcus aureus (S. aureus) has a high propensity to cause embolic events and cerebrovascular neurological complications. Methods: We conducted a single-center retrospective analysis, encompassing 529 patients who had undergone valve surgery for IE. Patients were divided according to causative microorganism into SA-IE and non-SA-IE groups. Subsequently, analyses of outcome differences between the two groups were performed, with a focus on neurological complications. Results: In the examined population, 128 (24.2%) had IE mediated by S. aureus. Patients with SA-IE were mostly male (69.3%) but had a higher proportion of females compared to non-SA-IE patients (30.7% vs. 21.8%; p = 0.039) and were significantly younger (61.1 [45.8–69.9] vs. 66.1 [54.3–74.4]; p = 0.002). Patients with SA-IE had comparable comorbidities to patients with non-SA-IE. Neurological complications were much more common in SA-IE (42.2%) compared to non-SA-IE (22.9%); (p < 0.001). Postoperative neurological complications were nearly equal in both groups—SA-IE 5.5% vs 6.2% in non-SA-IE (p = 0.752); 30-day mortality was significantly higher in patients with SA-IE vs. non-SA-IE (20.3% vs 12.5%; p = 0.028). However, the 1-year mortality rate did not differ between groups (29.4% vs. 22.2%; p = 0.121). Conclusions: Patients with SA-IE are subject to a higher incidence of neurological events prior to surgery and almost twice the short-term mortality rate compared to IE caused by other microorganisms. However, no observable discrepancy in the incidence of neurological events was found between SA- and non-SA-IE cases post-surgery.