Sixty-four cases of Staphylococcus aureus endocarditis between 1940 and 1971 were reviewed. There was no change in the incidence during these three decades. The over-all mortality was 41 and 86 per cent, respectively, in patients below and above age 50. The corresponding per cent mortality in the last decade of the study was lower, namely, 14 and 71 per cent. In four patients Staph. aureus endocarditis developed in the hospital. In two of these patients, endocarditis was associated with an infected indwelling intravenous catheter and in one, septic thrombophlebitis secondary to intravenous therapy was the presumed source. Endocarditis or bacteremia was not suspected clinically in 10 patients. Eight of them were over 70 years old; organic valvular heart disease was diagnosed in only one. A high index of suspicion is essential in the diagnosis of Staph, aureus endocarditis, since classic physical findings in subacute endocarditis are often absent. Endocarditis should be strongly suspected in the presence of Staph. aureus bacteremia.
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