Renzulli A, Carozza A, Marra C, Romano G P, Ismeno G, De Feo M, Della Corte A, Cotrufo M
Institute of Cardiac Surgery, Second University of Naples, V. Monaldi Hospital, Via L. Bianchi, Naples, Italy.
Eur J Cardiothorac Surg. 2000 Mar;17(3):228-33. doi: 10.1016/s1010-7940(00)00342-0.
To evaluate whether perioperative bacteria identification in blood and/or in valve cultures can predict early and late outcome of surgery for infective endocarditis, a retrospective study was performed.
Between January 1978 and December 1998, 232 patients, 79 (34.1%) female and 153 (65.9%) male with mean age of 44. 95+/-1.03 years (range 8-79) underwent surgery for infective endocarditis on a native (162 cases) or prosthetic (70 cases) valve. Patients were divided into three groups according to the perioperative x of microbiological tests: Group A: patients with preoperative positive blood cultures (83 cases); Group B: patients with positive valve cultures (35 cases); Group C: patients with negative blood and valve cultures (114 cases). Categorical values were compared by chi(2) analysis, whereas continuous data were compared by ANOVA and Bonferroni correction for post hoc comparisons. Analysis of late survival and complications was performed with Kaplan-Meier and Log Rank test. Late mortality, reoperation, perivalvular leak, recurrence of infection were considered as treatment failure. All data were presented as mean+/-standard error.
Hospital mortality was 10.8% (9/83) in Group A, 8.6% (3/35) in Group B, and 14.9% (17/114) in Group C (P=0.52; not significant (NS)). Ten-year survival was 62.7+/-8% in Group A, 43.9+/-19% in Group B and 62.7+/-7% in Group C (P=0.38; NS). Ten-year freedom from reoperation was 85.2+/-6% in Group A, 37.9+/-20% in Group B and 80+/-6% in Group C (P=0.0034). Ten-year freedom from treatment failure was 56.3+/-8% in Group A, 31.6+/-16% in Group B and 55. 3+/-7% in Group C (P=0.46; NS).
Positive blood and tissue cultures are not predictive for hospital mortality and late treatment failure in patients with infective endocarditis. Positive valve cultures, a common finding in patients with staphylococcal endocarditis, are predictive for a higher risk of reoperation.
为评估血液和/或瓣膜培养中的围手术期细菌鉴定能否预测感染性心内膜炎手术的早期和晚期结果，进行了一项回顾性研究。
在1978年1月至1998年12月期间，232例患者接受了感染性心内膜炎手术，其中79例（34.1%）为女性，153例（65.9%）为男性，平均年龄为44.95±1.03岁（范围8 - 79岁），手术涉及天然瓣膜（162例）或人工瓣膜（70例）。根据微生物检测的围手术期结果，患者被分为三组：A组：术前血培养阳性的患者（83例）；B组：瓣膜培养阳性的患者（35例）；C组：血培养和瓣膜培养均为阴性的患者（114例）。分类变量通过卡方分析进行比较，连续数据通过方差分析和Bonferroni校正进行事后比较。采用Kaplan - Meier法和Log Rank检验对晚期生存和并发症进行分析。晚期死亡率、再次手术、瓣周漏、感染复发被视为治疗失败。所有数据均以平均值±标准误表示。
A组医院死亡率为10.8%（9/83），B组为8.6%（3/35），C组为14.9%（17/114）（P = 0.52；无显著性差异（NS））。A组10年生存率为62.7±8%，B组为43.9±19%，C组为62.7±7%（P = 0.38；NS）。A组10年无再次手术率为85.2±6%，B组为37.9±20%，C组为80±6%（P = 0.0034）。A组10年无治疗失败率为56.3±8%，B组为31.6±16%，C组为55.3±7%（P = 0.46；NS）。
血培养和组织培养阳性对感染性心内膜炎患者的医院死亡率和晚期治疗失败无预测价值。瓣膜培养阳性是葡萄球菌性心内膜炎患者的常见表现，可预测再次手术风险较高。
