Tuğcu Aylin, Yildirimtürk Ozlem, Baytaroğlu Corç, Kurtoğlu Hilal, Köse Ozkan, Sener Murat, Aytekin Saide
Department of Cardiology, Florence Nightingale Hospital, Istanbul Bilim University, Istanbul, Turkey.
Turk Kardiyol Dern Ars. 2009 Jan;37(1):9-18.
This study was designed to evaluate clinical, laboratory, microbiological, and echocardiographic characteristics of infective endocarditis (IE) at a tertiary care center in Turkey and to identify predictors of in-hospital mortality.
Based on a systematic retrospective review of clinical records covering 1997 to 2007, we analyzed data and outcomes of 68 patients (40 males, 28 females; mean age 51+/-20 years) with definite or possible IE according to the modified Duke criteria.
Native valve endocarditis (NVE) was seen in 28 patients (41.2%), and prosthetic valve endocarditis (PVE) was seen in 38 patients (55.9%). Pacemaker endocarditis (PE) was observed in only two patients (2.9%). Nineteen patients (27.9%) had nosocomial IE. The most frequent predisposing factor for NVE was rheumatic heart disease (n=11; 39.3%). Echocardiography failed to show any signs of involvement in five patients (13.2%) with PVE. The most common causative microorganisms of NVE, PVE, and PE were staphylococci (n=28; 41.2%). At least one complication developed in 46 patients (67.7%), congestive heart failure being the most common (n=38; 55.9%). Forty-one patients (60.3%) underwent combined medical and surgical treatment. In-hospital mortality occurred in 17 patients (25%). Mortality rates were 37.5%, 30%, and 14.3% for early and late PVE and NVE, respectively. Mortality was significantly higher with nosocomial IE (57.9%) compared to 12.2% in the remaining patients. In multivariate analysis, septic shock (p=0.011) and nosocomial infection (p=0.032) were independently associated with in-hospital mortality.
Compared to the European series, IE in our cohort occurred in a relatively younger population, with rheumatic heart disease as the most common underlying heart disease. The rates of PVE, nosocomial IE, and surgical treatment were about the same.
本研究旨在评估土耳其一家三级医疗中心感染性心内膜炎（IE）的临床、实验室、微生物学及超声心动图特征，并确定院内死亡的预测因素。
基于对1997年至2007年临床记录的系统回顾，我们根据改良的杜克标准分析了68例确诊或可能患有IE患者（40例男性，28例女性；平均年龄51±20岁）的数据及结果。
28例患者（41.2%）为自体瓣膜心内膜炎（NVE），38例患者（55.9%）为人工瓣膜心内膜炎（PVE）。仅2例患者（2.9%）为起搏器心内膜炎（PE）。19例患者（27.9%）患有医院获得性IE。NVE最常见的易感因素是风湿性心脏病（n = 11；39.3%）。超声心动图未显示5例（13.2%）PVE患者有任何受累迹象。NVE、PVE和PE最常见的致病微生物是葡萄球菌（n = 28；41.2%）。46例患者（67.7%）至少发生一种并发症，充血性心力衰竭最为常见（n = 38；55.9%）。41例患者（60.3%）接受了药物和手术联合治疗。17例患者（25%）发生院内死亡。早期和晚期PVE及NVE的死亡率分别为37.5%、30%和14.3%。医院获得性IE的死亡率（57.9%）显著高于其余患者的12.2%。多因素分析显示，感染性休克（p = 0.011）和医院获得性感染（p = 0.032）与院内死亡独立相关。
与欧洲系列研究相比，我们队列中的IE发生在相对年轻的人群中，风湿性心脏病是最常见的潜在心脏病。PVE、医院获得性IE和手术治疗的发生率大致相同。
