感染性心内膜炎情况的变化：法国一项为期一年的调查结果

Changing profile of infective endocarditis: results of a 1-year survey in France.

作者信息

Hoen Bruno, Alla François, Selton-Suty Christine, Béguinot Isabelle, Bouvet Anne, Briançon Serge, Casalta Jean-Paul, Danchin Nicolas, Delahaye François, Etienne Jerome, Le Moing Vincent, Leport Catherine, Mainardi Jean-Luc, Ruimy Raymond, Vandenesch François

机构信息

Service de Maladies Infectieuses et Tropicales, University of Besançon Medical Center, Centre Hospitalier Universitaire de Besançon, F-25030 Besançon Cedex, France.

出版信息

JAMA. 2002 Jul 3;288(1):75-81. doi: 10.1001/jama.288.1.75.

DOI:10.1001/jama.288.1.75

PMID:12090865

Abstract

CONTEXT

Since the first modern clinical description of infective endocarditis (IE) at the end of the 19th century, the profile of the disease has evolved continuously, as highlighted in epidemiological studies including a French survey performed in 1991.

OBJECTIVE

To update information gained from the 1991 study on the epidemiology of IE in France.

DESIGN AND SETTING

Population-based survey conducted from January through December 1999 in all hospitals in 6 French regions representing 26% of the population (16 million inhabitants).

PATIENTS

Three hundred ninety adult inpatients diagnosed with IE according to Duke criteria.

MAIN OUTCOME MEASURES

Incidence of IE; proportion of patients with underlying heart disease; clinical characteristics; causative microorganisms; surgical and mortality outcomes.

RESULTS

The annual age- and sex-standardized incidence was 31 (95% confidence interval [CI], 28-35) cases per million, not including the region of New Caledonia, which had 161 (95% CI, 117-216) cases per million. There was no previously known heart disease in 47% of the cases. The proportion of prosthetic-valve IE was 16%. Causative microorganisms were: streptococci, 48% (group D streptococci, 25%; oral streptococci, 17%, pyogenic streptococci, 6%); enterococci, 8%; Abiotrophia species, 2%; staphylococci, 29%; and other or multiple pathogens, 8%. Blood cultures were negative in 9% and no microorganism was identified in 5% of the cases. Early valve surgery was performed in 49% of the patients. In-hospital mortality was 16%. Compared with 1991, this study showed a decreased incidence of IE in patients with previously known underlying heart disease (20.6 cases per million vs 15.1 cases per million; P<.001); a smaller incidence of oral streptococcal IE (7.8 cases per million vs 5.1 cases per million; P<.001), compensated by a larger proportion of IE due to group D streptococci (5.3 cases per million vs 6.2 cases per million; P =.67) and staphylococci (4.9 cases per million vs 5.7 cases per million; P =.97); an increased rate of early valve surgery (31.2% vs 49.7%; P<.001); and a decreased in-hospital mortality rate (21.6% vs 16.6%; P =.08).

CONCLUSION

Although the incidence of IE has not changed, important changes in disease characteristics, treatment, and outcomes were noted.

摘要

背景

自19世纪末首次对感染性心内膜炎（IE）进行现代临床描述以来，该疾病的特征一直在不断演变，1991年法国的一项调查等流行病学研究已对此予以强调。

目的

更新1991年法国IE流行病学研究所得信息。

设计与环境

1999年1月至12月在法国6个地区的所有医院开展基于人群的调查，这6个地区占法国人口的26%（1600万居民）。

患者

390例根据杜克标准诊断为IE的成年住院患者。

主要观察指标

IE发病率；有基础心脏病患者的比例；临床特征；致病微生物；手术及死亡率结局。

结果

年龄和性别标准化年发病率为每百万人口31例（95%置信区间[CI]，28 - 35），不包括新喀里多尼亚地区，该地区每百万人口有161例（95%CI，117 - 216）。47%的病例此前无已知心脏病。人工瓣膜性IE的比例为16%。致病微生物为：链球菌，48%（D组链球菌，25%；口腔链球菌，17%；化脓性链球菌，6%）；肠球菌，8%；嗜氨基酸菌属，2%；葡萄球菌，29%；其他或多种病原体，8%。9%的血培养结果为阴性，5%的病例未鉴定出微生物。49%的患者接受了早期瓣膜手术。住院死亡率为16%。与1991年相比，本研究显示既往有基础心脏病患者的IE发病率有所下降（每百万人口20.6例 vs 15.1例；P <.001）；口腔链球菌性IE的发病率降低（每百万人口7.8例 vs 5.1例；P <.001），但D组链球菌（每百万人口5.3例 vs 6.2例；P =.67）和葡萄球菌（每百万人口4.9例 vs 5.7例；P =.97）所致IE的比例有所增加；早期瓣膜手术率上升（31.2% vs 49.7%；P <.001）；住院死亡率下降（21.6% vs 16.6%；P =.08）。