Lefort Agnès, Lortholary Olivier, Casassus Philippe, Selton-Suty Christine, Guillevin Loïc, Mainardi Jean-Luc
Fédération de Médicine Interne, Maladies Infectieuses et Tropicales, Hôpital Avicenne, Université Paris-Nord, Bobigny, France.
Arch Intern Med. 2002 Nov 25;162(21):2450-6. doi: 10.1001/archinte.162.21.2450.
Limited data exist on infective endocarditis (IE) due to Streptococcus milleri (Sm) or beta-hemolytic streptococci (BHS). Because BHS and Sm share some physiologic and pathogenic properties, we wondered whether IE caused by these streptococci might present similarities.
Through a nationwide retrospective study in France, the medical and microbiologic charts of adults with definite Sm or BHS IE observed between January 1, 1991, and December 31, 1996, in university and general hospitals were reviewed.
Fifty-six patients had BHS IE (33 men and 23 women; median age, 59 years; range, 18-91 years) and 29 had Sm IE (18 men and 11 women; median age, 66 years; range, 37-97 years). The BHS group tended to have more underlying medical conditions (46%) and fewer previous cardiopathies (48%) than the Sm group (28% and 71%, respectively). Multivariate analysis showed that a longer median time of IE evolution before diagnosis and identification of the presumed portal of entry were independently associated with Sm IE (P<.01). Extracardiac complications were more frequent in the BHS group (55%) than in the Sm group (39%). Comparison of echocardiographic findings between the 2 groups did not establish any statistically significant difference. Thirty-six patients (64%) in the BHS group and 18 (62%) in the Sm group underwent valve replacement. Overall, mortality was 27% for the BHS group and 14% for the Sm group. For all patients, multivariate analysis retained older age as the only significant risk factor for death (P =.01).
Compared with Sm IE, BHS IE occurs in younger patients with more underlying diseases and fewer underlying cardiopathies and has a more aggressive presentation and evolution.
关于米勒链球菌（Sm）或β溶血性链球菌（BHS）所致感染性心内膜炎（IE）的数据有限。由于BHS和Sm具有一些生理和致病特性，我们想知道这些链球菌所致的IE是否可能存在相似之处。
通过在法国进行的一项全国性回顾性研究，对1991年1月1日至1996年12月31日期间在大学医院和综合医院确诊为Sm或BHS所致IE的成年患者的医学和微生物学病历进行了回顾。
56例患者患有BHS所致IE（33例男性和23例女性；中位年龄59岁；范围18 - 91岁），29例患有Sm所致IE（18例男性和11例女性；中位年龄66岁；范围37 - 97岁）。与Sm组（分别为28%和71%）相比，BHS组往往有更多的基础疾病（46%）和更少的既往心脏病史（48%）。多变量分析显示，诊断前IE病程的中位时间较长以及确定推测的感染入口与Sm所致IE独立相关（P<0.01）。BHS组的心外并发症（55%）比Sm组（39%）更常见。两组超声心动图检查结果的比较未发现任何统计学上的显著差异。BHS组36例患者（64%）和Sm组18例患者（62%）接受了瓣膜置换。总体而言，BHS组的死亡率为27%，Sm组为14%。对于所有患者，多变量分析显示年龄较大是唯一显著的死亡危险因素（P = 0.01）。
与Sm所致IE相比，BHS所致IE发生在基础疾病较多、既往心脏病较少的年轻患者中，其临床表现和病情进展更具侵袭性。
