alexa Staphylococcus aureus endocarditis: a consequence of medical progress.
Business & Management

Business & Management

Journal of Accounting & Marketing

Author(s): Fowler VG Jr, Miro JM, Hoen B, Cabell CH, Abrutyn E,

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Abstract 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. This article was published in JAMA and referenced in Journal of Accounting & Marketing

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