Oyonarte Miguel, Montagna Rodrigo, Braun Sandra, Maiers Emilio, Rojo Pamela, Cumsille José Francisco
Centro Cardiovascular, Hospital Clínico Universidad de Chile, Santos Dumont 999, Independencia, Santiago.
Rev Med Chil. 2003 Mar;131(3):237-50.
Infective endocarditis is a severe condition, with a mortality that fluctuates between 16 and 25% in the Metropolitan area of Chile.
To perform a prospective assessment of clinical and microbiological features of patients with infective endocarditis in Chile.
Collaborative study of regional hospitals in the whole country and teaching hospitals in Santiago. Patients with a possible or definitive infective endocarditis, according to Duke's criteria, were included in the protocol and a structured data entry form was completed.
Three hundred twenty one patients (65% male, mean age 49 +/- 16.5 years) were studied. According Duke's criteria, 89% had a definitive and 11% a possible endocarditis. The subacute form occurred in 64% of patients. The most frequent predisposing cardiopathies were rheumatic in 25%, prosthetic valves in 15% and congenital in 13%. There was no evidence of cardiopathy in 20%. Twenty percent of patients were on hemodialysis, 11% were diabetic and only one patient abused intravenous drugs. The most frequent complication was cardiac failure in 59% of cases, followed by renal failure in 32% and embolism in 28%. The most frequent causing organism was coagulase positive Staphylococcus in 35%. Blood cultures were negative in 28% of cases from the metropolitan region, in 56% of cases from the north and 38% of cases from the south. Echocardiographic diagnosis was done in 92% of cases. Aortic valve was involved in 42% and mitral valve in 29%. Successful antimicrobial treatment was achieved in 59% of patients. Thirty five percent of patients were subjected to surgical procedures with a 78% survival. Overall mortality was 29%. Univariate analysis identified sepsis, an age over 60 years and the presence of cardiac or renal failure as prognostic indicators of mortality. On multivariate analysis, the identified prognostic indicators were the presence of sepsis, renal failure, mitroaortic involvement associated to combined surgery and failure of antimicrobial treatment not associated to surgery.
Subacute form is the most common presentation of infective endocarditis and rheumatic valve disease is the most common underlying cardiac lesion. Intravenous drugs users infective endocarditis is exceptional in Chile. The most frequent causing agent is coagulase positive Staphylococcus and the most frequent complication is cardiac failure. Surgical and overall mortality were 22 and 29% respectively. Sepsis, renal failure, combined surgical procedures, failure of medical treatment were identified as prognostic indicators of mortality.
感染性心内膜炎是一种严重疾病，在智利首都地区，其死亡率在16%至25%之间波动。
对智利感染性心内膜炎患者的临床和微生物学特征进行前瞻性评估。
对全国各地区医院和圣地亚哥的教学医院进行合作研究。根据杜克标准，可能患有或确诊为感染性心内膜炎的患者被纳入研究方案，并填写结构化数据录入表。
共研究了321例患者（65%为男性，平均年龄49±16.5岁）。根据杜克标准，89%为确诊的心内膜炎，11%为可能的心内膜炎。亚急性形式见于64%的患者。最常见的易患心脏病为风湿性心脏病，占25%；人工瓣膜，占15%；先天性心脏病，占13%。20%的患者未发现心脏病证据。20%的患者接受血液透析，11%为糖尿病患者，仅有1例患者滥用静脉药物。最常见的并发症是心力衰竭，占59%的病例，其次是肾衰竭，占32%，栓塞占28%。最常见的致病微生物是凝固酶阳性葡萄球菌，占35%。首都地区28%的病例、北部地区56%的病例和南部地区38%的病例血培养为阴性。92%的病例进行了超声心动图诊断。主动脉瓣受累占42%，二尖瓣受累占29%。59%的患者抗菌治疗成功。35%的患者接受了外科手术，手术生存率为78%。总体死亡率为29%。单因素分析确定败血症、年龄超过60岁以及存在心脏或肾衰竭是死亡率预后指标。多因素分析确定的预后指标为败血症、肾衰竭、与联合手术相关的二尖瓣主动脉瓣受累以及与手术无关的抗菌治疗失败。
亚急性形式是感染性心内膜炎最常见的表现形式，风湿性瓣膜病是最常见的潜在心脏病变。在智利，静脉药物使用者感染性心内膜炎较为罕见。最常见的致病病原体是凝固酶阳性葡萄球菌，最常见的并发症是心力衰竭。手术死亡率和总体死亡率分别为22%和29%。败血症、肾衰竭、联合手术、药物治疗失败被确定为死亡率预后指标。
