Tissières P, Jaeggi E T, Beghetti M, Gervaix A
Medical ICU laboratory, Dept. of Microbiology and Molecular Medicine, University of Geneva Medical School, CMU-Rue Michel-Servet 1, 1211 Geneva 4, Switzerland.
Infection. 2005 Aug;33(4):267-72. doi: 10.1007/s15010-005-4122-4.
Infective endocarditis (IE) is a rare and feared infection that mainly occurs in patients with underlying cardiac disease or altered function of the immune system. Recent epidemiological data on both sepsis and nosocomial infections indicate a rise in gram-negative bacterial and fungal infection, particularly in patients requiring critical care support. This study sought to characterize the change in the spectrum of IE encountered in a single pediatric tertiary care center during the last 18 years, to evaluate emergence of fungal IE and to identify contributing factors.
Review of all cases of IE diagnosed between January 1986 and August 2003 at a single university children's hospital. Patients were distributed between two equal time periods and compared according to the era of IE diagnosis.
In 43 patients, 44 episodes of IE were identified with most cases occurring in children with congenital or acquired heart disease. The annual number of diagnosed cases fluctuated during the study (mean 2.4 cases/year). Blood or specimen cultures were positive in 34 cases (77%) with gram-positive organisms most frequently observed (n=20, 44.4%). Fungal IE cases (n=9, 20%) occurred preferentially during the second period (p<0.03), and were more common in children with noncardiac diseases (p=0.023). Factors associated with fungal IE were the use of broad-spectrum antibiotics (p<0.001) and the presence of an infected central venous catheter (p=0.01). Overall mortality did not differ between the two eras.
The incidence of fungal IE seems to have significantly increased in more recent years. Use of broadspectrum antibiotics for prolonged time or/and central venous catheters were identified as predisposing factors to fungal infective endocarditis.
感染性心内膜炎（IE）是一种罕见且令人担忧的感染性疾病，主要发生在患有基础心脏病或免疫系统功能改变的患者中。近期关于败血症和医院感染的流行病学数据表明，革兰氏阴性菌和真菌感染有所增加，尤其是在需要重症监护支持的患者中。本研究旨在描述过去18年中一家儿科三级护理中心所遇到的IE谱的变化，评估真菌性IE的出现情况，并确定相关因素。
回顾1986年1月至2003年8月间在一家大学儿童医院诊断的所有IE病例。患者被分为两个相等的时间段，并根据IE诊断的时代进行比较。
在43例患者中，共确诊44例IE发作，大多数病例发生在患有先天性或后天性心脏病的儿童中。在研究期间，每年确诊的病例数有所波动（平均每年2.4例）。34例（77%）血培养或标本培养呈阳性，最常观察到的是革兰氏阳性菌（n = 20，44.4%）。真菌性IE病例（n = 9，20%）在第二个时间段更为常见（p < 0.03），并且在非心脏病患儿中更常见（p = 0.023）。与真菌性IE相关的因素是使用广谱抗生素（p < 0.001）和存在感染的中心静脉导管（p = 0.01）。两个时代的总体死亡率没有差异。
近年来，真菌性IE的发病率似乎显著增加。长时间使用广谱抗生素和/或中心静脉导管被确定为真菌性感染性心内膜炎的易感因素。
