城市医疗中心的感染性心内膜炎：个别药物与瓣膜受累的关联。

Infective endocarditis in an urban medical center: association of individual drugs with valvular involvement.

作者信息

Jain Vivek, Yang Meei-Horng, Kovacicova-Lezcano Gabriela, Juhle Leah S, Bolger Ann F, Winston Lisa G

机构信息

Department of Internal Medicine, University of California, San Francisco; San Francisco General Hospital, San Francisco, CA, USA.

出版信息

J Infect. 2008 Aug;57(2):132-8. doi: 10.1016/j.jinf.2008.05.008. Epub 2008 Jul 1.

DOI:10.1016/j.jinf.2008.05.008

PMID:18597851

Abstract

OBJECTIVES

Injection drug users (IDUs) develop more right-sided infective endocarditis (IE) than non-IDUs, but it is not known whether this risk is specific to any particular injected drug. This study reviews the clinical characteristics of IE in an urban population and examines the association of drug type with manifestations of IE.

METHODS

A retrospective cohort of 247 cases of IE was analyzed. Demographic, clinical, microbiologic, and echocardiographic data were collected.

RESULTS

Our cohort featured a 74% IDU rate, most with heroin. Staphylococcus aureus was the most prevalent organism. S. aureus IE was more likely to occur in IDUs versus non-IDUs (OR 5.5, p<0.0001). Enterococcus faecalis IE was less likely to occur in IDUs (OR 0.21, p=0.02). Tricuspid valve (TV) IE was more likely to occur in IDUs (OR 4.37, p=0.001), while mitral valve (MV) IE occurred less commonly in IDUs (OR 0.40, p=0.005). TV IE occurred more frequently in heroin users vs. IDUs not using heroin (OR 4.03, p=0.033).

CONCLUSIONS

The epidemiology of IE in this cohort is different from that reported recently in other cohorts, likely due to the high prevalence of IDU. Heroin use may underlie the association between IDU and right-sided endocarditis.

摘要

目的

注射吸毒者（IDU）比非注射吸毒者更容易发生右侧感染性心内膜炎（IE），但尚不清楚这种风险是否特定于任何一种特定的注射药物。本研究回顾了城市人群中IE的临床特征，并研究了药物类型与IE表现之间的关联。

方法

对247例IE病例进行回顾性队列分析。收集人口统计学、临床、微生物学和超声心动图数据。

结果

我们的队列中IDU率为74%，大多数使用海洛因。金黄色葡萄球菌是最常见的病原体。与非IDU相比，IDU更易发生金黄色葡萄球菌性IE（比值比5.5，p<0.0001）。粪肠球菌性IE在IDU中发生的可能性较小（比值比0.21，p=0.02）。三尖瓣（TV）IE在IDU中更易发生（比值比4.37，p=0.001），而二尖瓣（MV）IE在IDU中较少见（比值比0.40，p=0.005）。与不使用海洛因的IDU相比，海洛因使用者中TV IE更常见（比值比4.03，p=0.033）。