Hsu Ron-Bin, Lin Fang-Yue
Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan, Republic of China.
Infect Control Hosp Epidemiol. 2007 Jul;28(7):860-6. doi: 10.1086/518727. Epub 2007 May 25.
Infective endocarditis caused by Staphylococcus aureus is an ominous prognosis associated with a high prevalence of embolic episodes and neurological involvement. Whether methicillin resistance decreases the risk of embolism in infective endocarditis is unclear. We sought to assess the association between methicillin resistance and risk factors for embolism in S. aureus infective endocarditis.
Retrospective chart review. Data from patients with infective endocarditis due to methicillin-resistant S. aureus were compared with data from patients with endocarditis due to methicillin-susceptible S. aureus. Logistic regression was used to identify independent risk factors for embolism.
A 2,000-bed, university-affiliated tertiary care hospital.
Between 1995 and 2005, 123 patients with S. aureus infective endocarditis were included in the study. There were 74 male patients and 49 female patients, with a median age of 54 years (range, 0-89 years).
Of 123 infections, 30 (24%) were nosocomial infections, and 14 (11%) were prosthetic valve infections. Of 123 S. aureus isolates, 48 (39%) were methicillin resistant. In total, embolism occurred in 45 (37%) of these patients: pulmonary embolism in 22 (18%), cerebral embolism in 21 (17%), and peripheral embolism in 6 (5%). The independent risk factors for an embolism were injection drug use, presence of a cardiac vegetation with a size of 10 mm or greater, and absence of nosocomial infection. For 83 patients with aortic or mitral infective endocarditis, independent risk factors for an embolism were the presence of a cardiac vegetation with a size of 10 mm or greater and endocarditis due to methicillin-susceptible S. aureus. Overall, in-hospital death occurred for 32 (26%) of 123 patients. Methicillin-resistant infection was not an independent risk factor for death.
Methicillin-resistant S. aureus infection was associated with decreased risk of embolism in left-side endocarditis, but was not associated with in-hospital death.
金黄色葡萄球菌引起的感染性心内膜炎预后不佳，与栓塞事件和神经系统受累的高发生率相关。耐甲氧西林是否会降低感染性心内膜炎的栓塞风险尚不清楚。我们试图评估耐甲氧西林与金黄色葡萄球菌感染性心内膜炎栓塞危险因素之间的关联。
回顾性病历审查。将耐甲氧西林金黄色葡萄球菌所致感染性心内膜炎患者的数据与甲氧西林敏感金黄色葡萄球菌所致心内膜炎患者的数据进行比较。采用逻辑回归分析确定栓塞的独立危险因素。
一家拥有2000张床位的大学附属医院三级医疗中心。
1995年至2005年期间，123例金黄色葡萄球菌感染性心内膜炎患者纳入研究。其中男性74例，女性49例，中位年龄54岁（范围0 - 89岁）。
123例感染中，30例（24%）为医院感染，14例（11%）为人工瓣膜感染。123株金黄色葡萄球菌分离株中，48株（39%）耐甲氧西林。这些患者中共有45例（37%）发生栓塞：肺栓塞22例（18%），脑栓塞21例（17%），外周栓塞6例（5%）。栓塞的独立危险因素为注射吸毒、存在大小为10 mm或更大的心脏赘生物以及无医院感染。对于83例主动脉或二尖瓣感染性心内膜炎患者，栓塞的独立危险因素为存在大小为10 mm或更大的心脏赘生物以及甲氧西林敏感金黄色葡萄球菌所致的心内膜炎。总体而言，123例患者中有32例（26%）在住院期间死亡。耐甲氧西林感染不是死亡的独立危险因素。
耐甲氧西林金黄色葡萄球菌感染与左侧心内膜炎栓塞风险降低相关，但与住院死亡无关。
