Røder B L, Wandall D A, Frimodt-Møller N, Espersen F, Skinhøj P, Rosdahl V T
Division of Microbiology, Statens Serum Institut, Copenhagen, Denmark.
Arch Intern Med. 1999 Mar 8;159(5):462-9. doi: 10.1001/archinte.159.5.462.
Both morbidity and mortality resulting from Staphylococcus aureus endocarditis are known to be high, and the incidence of this disease seems to increase. The Statens Serum Institut, Copenhagen, Denmark, made it possible for us to analyze the clinical features of S aureus endocarditis in a nation-wide population of non-drug addicts.
Almost all Danish cases of bacteremia due to S aureus are reported to the Staphylococcus laboratory, Statens Serum Institut. The medical records were reviewed in cases reported from 1982 to 1991 in which the diagnosis of endocarditis was reported or suspected.
A total of 260 patients, 145 males and 115 females, fulfilled the diagnostic criteria. The median age was 67.5 years. In 83 patients, the diagnosis of endocarditis was not suspected clinically. The overall mortality rate among those patients whose disease was diagnosed clinically was 46%. Among the subset of patients who received medical therapy only and appropriate antistaphylococcal treatment, mortality was significantly associated with late congestive heart failure, age, and involvement of the central nervous system.
A raised awareness of the paucity of clinical findings and a more frequent use of echocardiography as a screening method seem essential to improve the prognosis of patients with S aureus endocarditis. Involvement of the central nervous system constitutes a relative indication of early valve replacement.
金黄色葡萄球菌性心内膜炎导致的发病率和死亡率均很高，且该病的发病率似乎在上升。丹麦哥本哈根的国家血清研究所使我们能够分析全国范围内非吸毒成瘾者中金黄色葡萄球菌性心内膜炎的临床特征。
几乎所有丹麦的金黄色葡萄球菌菌血症病例都报告给了国家血清研究所的葡萄球菌实验室。对1982年至1991年报告或疑似心内膜炎诊断的病例的病历进行了回顾。
共有260例患者符合诊断标准，其中男性145例，女性115例。中位年龄为67.5岁。83例患者临床上未怀疑心内膜炎诊断。临床诊断疾病的患者总体死亡率为46%。在仅接受药物治疗和适当抗葡萄球菌治疗的患者亚组中，死亡率与晚期充血性心力衰竭、年龄和中枢神经系统受累显著相关。
提高对临床发现不足的认识以及更频繁地使用超声心动图作为筛查方法似乎对于改善金黄色葡萄球菌性心内膜炎患者的预后至关重要。中枢神经系统受累是早期瓣膜置换的相对指征。
