Olaison Lars, Schadewitz Kimmo
Department of Infectious Diseases, Sahlgrenska University Hospital, Göteborg University, Göteborg, Sweden.
Clin Infect Dis. 2002 Jan 15;34(2):159-66. doi: 10.1086/338233. Epub 2001 Dec 7.
A 5-year nationwide prospective study in Sweden during 1995-1999 identified 881 definite episodes of infective endocarditis. Definite enterococcal endocarditis was diagnosed in 93 episodes (11%), the largest series of enterococcal endocarditis so far presented. Mortality during treatment was 16%, the relapse rate was 3%, and clinical cure was achieved in the remaining 81% of the episodes. Clinical cure was achieved with a median duration of cell wall-active antimicrobial therapy of 42 days combined with an aminoglycoside (median treatment time, 15 days). International guidelines generally recommend a 4-6-week combined synergistic treatment course with a cell wall-active antibiotic and an aminoglycoside. Treatment regimens in Sweden often include a shortened aminoglycoside treatment course in order to minimize adverse effects in older patients. Fatal outcome seemed not to be due to the shortened aminoglycoside therapy course. In many enterococcal endocarditis episodes, duration of aminoglycoside therapy could probably be shortened to 2-3 weeks.
1995年至1999年期间在瑞典进行的一项为期5年的全国性前瞻性研究确定了881例明确的感染性心内膜炎发作。93例（11%）被诊断为明确的肠球菌性心内膜炎，是迄今为止报道的最大系列的肠球菌性心内膜炎。治疗期间的死亡率为16%，复发率为3%，其余81%的发作实现了临床治愈。通过中位持续时间为42天的细胞壁活性抗菌治疗联合氨基糖苷类药物（中位治疗时间为15天）实现了临床治愈。国际指南一般推荐使用细胞壁活性抗生素和氨基糖苷类药物进行4至6周的联合协同治疗疗程。瑞典的治疗方案通常包括缩短氨基糖苷类药物的治疗疗程，以尽量减少老年患者的不良反应。致命结局似乎并非由于氨基糖苷类药物治疗疗程缩短所致。在许多肠球菌性心内膜炎发作中，氨基糖苷类药物的治疗疗程可能可以缩短至2至3周。
