NEW reseach has shown that coagulase-negative staphylococcal infective endocarditis (CoNSIE) accounts for 18.4% of infective endocarditis (IE) cases in Spain, with distinct clinical characteristics and high mortality rates that have improved over time.
Infective endocarditis caused by coagulase-negative staphylococci (CoNS) has become more prevalent, yet large-scale contemporary data on its epidemiology, clinical profile, and outcomes are limited. This study analysed a nationwide Spanish cohort to compare CoNSIE with Staphylococcus aureus IE (SAIE), as well as to differentiate between cases caused by Staphylococcus epidermidis, S. lugdunensis, and other CoNS species. Understanding these differences is crucial for optimising diagnosis, management, and prognosis in clinical practice.
A post hoc analysis was conducted on the GAMES cohort, comprising 4,567 consecutive definitive IE cases from 44 Spanish centres between 2008 and 2022. Among these, 842 cases were CoNSIE and 1,109 were SAIE. S. epidermidis was the most common CoNS species (76.8%), followed by S. lugdunensis (6.4%) and other species such as S. capitis, S. haemolyticus, and S. hominis. Patients with CoNSIE were older, more likely to have pre-existing heart disease, and had higher rates of prosthetic valve involvement, nosocomial acquisition, and methicillin resistance than those with SAIE. Despite these complexities, in-hospital mortality was slightly lower in CoNSIE (32.8% vs 37.1%, p = 0.049), with no significant difference in 1-year mortality. S. lugdunensis infections presented with more acute pathology, including leaflet perforation and rupture, but overall mortality remained high across all CoNS groups. Independent prognostic factors included septic shock, heart failure, and cardiac surgery (which was protective), while no specific staphylococcal species independently influenced mortality. Encouragingly, each five-year study period was associated with a decline in in-hospital and one-year mortality.
These findings highlight the ongoing challenge of managing CoNSIE, given its complexity and high mortality. However, improvements over time suggest advancements in clinical care and surgical intervention. Future efforts should focus on refining diagnostic strategies, antimicrobial stewardship, and optimising surgical decision-making to further enhance patient outcomes. Increased awareness of species-specific characteristics may also aid in tailoring treatment approaches, ensuring that CoNSIE is recognised as a distinct and evolving clinical entity within infective endocarditis management.
Katrina Thornber, EMJ
Reference
Palom-Grau C et al. A contemporary picture of coagulase-negative staphylococcal endocarditis: a nationwide GAMES cohort study. JACC. 2025;85(4):305-18.
