Moreillon Philippe, Que Yok-Ai
Institute of Fundamental Microbiology, Centre Hospitalier Universitaire, University of Lausanne, Switzerland.
Lancet. 2004 Jan 10;363(9403):139-49. doi: 10.1016/S0140-6736(03)15266-X.
Despite improvements in health care, the incidence of infective endocarditis has not decreased over the past decades. This apparent paradox is explained by a progressive evolution in risk factors; while classic predisposing conditions such as rheumatic heart disease have been all but eradicated, new risk factors for infective endocarditis have emerged. These include intravenous drug use, sclerotic valve disease in elderly patients, use of prosthetic valves, and nosocomial disease. Newly identified pathogens, which are difficult to cultivate--eg, Bartonella spp and Tropheryma whipplei--are present in selected individuals, and resistant organisms are challenging conventional antimicrobial therapy. Keeping up with these changes depends on a comprehensive approach, allying understanding of the pathogenesis of disease with the development of new drugs for infective endocarditis. Infection by staphylococci and streptococci is being dissected at the molecular level. New ideas for antimicrobial agents are being developed. These novel insights should help redefine preventive and therapeutic strategies against infective endocarditis.
尽管医疗保健有所改善，但在过去几十年中，感染性心内膜炎的发病率并未下降。这种明显的矛盾可以通过危险因素的逐步演变来解释；虽然诸如风湿性心脏病等经典的易感疾病几乎已被根除，但感染性心内膜炎的新危险因素却出现了。这些因素包括静脉吸毒、老年患者的硬化瓣膜病、人工瓣膜的使用以及医院内感染。新发现的难以培养的病原体，如巴尔通体属和惠普尔嗜组织细胞菌，存在于特定个体中，而耐药菌正对传统抗菌治疗构成挑战。跟上这些变化需要采取综合方法，将对疾病发病机制的理解与开发用于感染性心内膜炎的新药相结合。葡萄球菌和链球菌感染正在分子水平上进行剖析。正在开发抗菌药物的新思路。这些新见解应有助于重新定义针对感染性心内膜炎的预防和治疗策略。
