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

<b>Background:</b><i>Staphylococcus aureus</i> 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 <i>Staphylococcus aureus</i> (<i>S. aureus</i>) has a high propensity to cause embolic events and cerebrovascular neurological complications. <b>Methods:</b> 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. <b>Results:</b> In the examined population, 128 (24.2%) had IE mediated by <i>S. aureus</i>. 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%; <i>p</i> = 0.039) and were significantly younger (61.1 [45.8-69.9] vs. 66.1 [54.3-74.4]; <i>p</i> = 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%); (<i>p</i> < 0.001). Postoperative neurological complications were nearly equal in both groups-SA-IE 5.5% vs 6.2% in non-SA-IE (<i>p</i> = 0.752); 30-day mortality was significantly higher in patients with SA-IE vs. non-SA-IE (20.3% vs 12.5%; <i>p</i> = 0.028). However, the 1-year mortality rate did not differ between groups (29.4% vs. 22.2%; <i>p</i> = 0.121). <b>Conclusions:</b> 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.