Ireland James H.E., McCarthy James T.
Mayo Clinic and Mayo Foundation, 200 First Street, SW, Rochester, MN 55905, USA.
Curr Infect Dis Rep. 2003 Aug;5(4):293-299. doi: 10.1007/s11908-003-0005-y.
Physicians who treat patients with infective endocarditis (IE) are encountering a growing number of dialysis and kidney transplant patients. Both groups have 30 to 100 times higher risk of IE, with 1-year mortalities of 40% to 60%. The predominant organisms causing IE are gram positive, with 60% to 80% of cases due to Staphylococcus aureus, and another 10% to 20% of cases due to coagulase-negative staphylococci. Renal transplant patients may develop fungal IE, but this risk is primarily in the first 3 months after transplant. In addition to blood cultures, transesophageal echocardiogram is the most useful diagnostic examination for IE in these patients. Initial antibiotic therapy, pending final culture and antibiotic susceptibility results, should provide coverage against the most common organisms and allow for the potential of either methicillin or vancomycin-resistant species. Removal of infected hemodialysis access devices and at least 4 to 6 weeks of intravenous antibiotics are recommended. Antibiotic prophylaxis against IE has been recommended for all dialysis and renal transplant patients, but this strategy is controversial and unproven.
治疗感染性心内膜炎（IE）患者的医生正面临着越来越多的透析患者和肾移植患者。这两类患者患IE的风险比常人高30至100倍，1年死亡率为40%至60%。引起IE的主要病原体为革兰氏阳性菌，60%至80%的病例由金黄色葡萄球菌引起，另有10%至20%的病例由凝固酶阴性葡萄球菌引起。肾移植患者可能会发生真菌性IE，但这种风险主要出现在移植后的前3个月。除血培养外，经食管超声心动图是诊断这些患者IE最有用的检查方法。在最终培养结果和抗生素敏感性结果出来之前，初始抗生素治疗应覆盖最常见的病原体，并考虑到耐甲氧西林或耐万古霉素菌株的可能性。建议移除受感染的血液透析通路装置，并进行至少4至6周的静脉抗生素治疗。已建议对所有透析和肾移植患者进行IE的抗生素预防，但这一策略存在争议且未经证实。
