Calza Leonardo, Manfredi Roberto, Chiodo Francesco
Department of Clinical and Experimental Medicine, Division of Infectious Diseases, Alma Mater Studiorum University of Bologna, S. Orsola Hospital, via G. Massarenti 11, I-40138 Bologna, Italy.
Expert Opin Pharmacother. 2004 Sep;5(9):1899-916. doi: 10.1517/14656566.5.9.1899.
Despite significant advances in antimicrobial therapy and an enhanced ability to diagnose and treat complications, infective endocarditis is still associated with substantial morbidity and mortality today, and its incidence has not decreased over the past decades. This apparent paradox may be explained by a progressive change in risk factors, leading to an evolution in its epidemiological and clinical features. In fact, new risk factors for endocarditis have emerged, such as intravenous drug abuse, diffusion of heart surgery procedures and prosthetic valve implantation, atherosclerotic valve disease in elderly patients, and nosocomial disease. Recently identified microorganisms (including Bartonella spp., Abiotrophia defectiva, and the HACEK group of bacteria [including Haemophilus spp., Actinobacillus spp., Cardiobacterium hominis, Eikenella corrodens and Kingella kingae]) are sometimes the cause of culture-negative endocarditis, and emerging resistant bacteria (such as methicillin- or vancomycin-resistant Staphylococci and vancomycin-resistant Enterococci) are becoming a new challenge for conventional antibiotic therapy. New therapeutic approaches need to be developed for the treatment of infective endocarditis caused by drug-resistant Gram-positive cocci, and some antimicrobial compounds recently introduced in clinical practice (such as streptogramins and oxazolidinones) may be an effective alternative, but further clinical studies are needed in order to confirm their effectiveness and safety. This review should help redefine the best therapeutic and preventive strategies against infective endocarditis.
尽管抗菌治疗取得了重大进展，诊断和治疗并发症的能力也有所增强，但感染性心内膜炎如今仍与较高的发病率和死亡率相关，且在过去几十年中其发病率并未下降。这种明显的矛盾现象或许可以通过危险因素的逐渐变化来解释，这导致了其流行病学和临床特征的演变。事实上，心内膜炎的新危险因素已经出现，如静脉药物滥用、心脏手术和人工瓣膜植入的普及、老年患者的动脉粥样硬化瓣膜病以及医院内感染。最近发现的微生物（包括巴尔通体属、缺陷嗜氨基酸菌以及HACEK菌群[包括嗜血杆菌属、放线杆菌属、人心杆菌、腐蚀埃肯菌和金氏金杆菌]）有时是血培养阴性心内膜炎的病因，而新出现的耐药菌（如耐甲氧西林或耐万古霉素葡萄球菌以及耐万古霉素肠球菌）正成为传统抗生素治疗的新挑战。需要开发新的治疗方法来治疗由耐药革兰氏阳性球菌引起的感染性心内膜炎，临床实践中最近引入的一些抗菌化合物（如链阳菌素和恶唑烷酮）可能是一种有效的替代药物，但还需要进一步的临床研究来证实其有效性和安全性。这篇综述应有助于重新定义针对感染性心内膜炎的最佳治疗和预防策略。
