Devlin Roni K, Andrews Mary-Margaret, von Reyn C Fordham
Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA.
Curr Opin Cardiol. 2004 Mar;19(2):134-9. doi: 10.1097/00001573-200403000-00012.
Infective endocarditis continues to pose major challenges in diagnosis and management despite advances in understanding the epidemiology, microbiology, and pathology of the disease. The purpose of this article is to provide a review of diagnosis, microbiology, and treatment of infective endocarditis, particularly as they are influenced by case definitions.
Case definitions have a critical effect on the interpretation of trends in infective endocarditis, and recent studies have proposed more specific criteria. Studies have also addressed the appropriate use of echocardiography to assist in the diagnosis and management of infective endocarditis. Staphylococcus aureus has become an increasingly common cause of infective endocarditis, and the microbiology of nosocomial infective endocarditis is changing. Newer techniques are being used to aid in the identification of causal agents in blood culture-negative infective endocarditis. Antimicrobial guidelines for the treatment of infective endocarditis are readily available, including a proposal to avoid premature discharge of patients on outpatient antibiotic therapy. Additional studies have been conducted on combination antibiotic therapy, duration of treatment, dosing of aminoglycosides, alternative agents for gram-positive organisms, aspirin therapy, and surgical interventions.
Recent trends in diagnosis, microbiology, and treatment of infective endocarditis are described, and case definitions play a critical role in their interpretation.
尽管在了解感染性心内膜炎的流行病学、微生物学和病理学方面取得了进展，但该病在诊断和管理上仍面临重大挑战。本文旨在综述感染性心内膜炎的诊断、微生物学及治疗，尤其是受病例定义影响的方面。
病例定义对感染性心内膜炎趋势的解读有至关重要的影响，近期研究提出了更具体的标准。研究还探讨了超声心动图在感染性心内膜炎诊断和管理中的合理应用。金黄色葡萄球菌已成为感染性心内膜炎越来越常见的病因，医院获得性感染性心内膜炎的微生物学正在发生变化。正在使用更新的技术来帮助识别血培养阴性感染性心内膜炎的病原体。现有感染性心内膜炎治疗的抗菌指南，包括一项关于避免门诊抗生素治疗患者过早出院的提议。关于联合抗生素治疗、治疗持续时间、氨基糖苷类药物剂量、革兰氏阳性菌替代药物、阿司匹林治疗及手术干预，也进行了更多研究。
描述了感染性心内膜炎诊断、微生物学和治疗的近期趋势，病例定义在其解读中起关键作用。
