Rice L B, Calderwood S B, Eliopoulos G M, Farber B F, Karchmer A W
Department of Medicine, New England Deaconess Hospital, Boston, Massachusetts 02115.
Rev Infect Dis. 1991 Jan-Feb;13(1):1-7. doi: 10.1093/clinids/13.1.1.
Between 1973 and 1987, 36 patients with 41 episodes of enterococcal endocarditis were seen at our institution. There were 22 episodes of native valve endocarditis (NVE) and 19 episodes of prosthetic valve endocarditis (PVE). The overall mortality before completion of therapy was 15% (18% due to NVE and 11% due to PVE). Among patients with NVE, involvement of the aortic valve was significantly associated with death or complicated illness (defined as the need for valve replacement before completion of antibiotic therapy or relapse of endocarditis after completion of therapy). Among patients who survived episodes of PVE, 69% were cured without surgical intervention. Gentamicin was administered in combination with a penicillin or vancomycin in the majority of episodes (mean duration of therapy with aminoglycosides: 5 weeks). Renal dysfunction occurred in 44% of patients who received gentamicin and occurred more frequently in patients with elevated serum creatinine levels before treatment. Our results suggest that enterococcal PVE can often be successfully treated with antibiotics alone, and they confirm the efficacy of gentamicin when it is administered in combination with cell wall-active agents for the treatment of endocarditis due to enterococci that lack high-level resistance to this agent.
1973年至1987年间，我院共收治36例肠球菌性心内膜炎患者，共发作41次。其中有22次为自体瓣膜心内膜炎（NVE），19次为人工瓣膜心内膜炎（PVE）。治疗结束前的总死亡率为15%（NVE导致的死亡率为18%，PVE导致的死亡率为11%）。在NVE患者中，主动脉瓣受累与死亡或病情复杂显著相关（病情复杂定义为在抗生素治疗结束前需要进行瓣膜置换或治疗结束后心内膜炎复发）。在PVE发作后存活的患者中，69%未经手术干预即治愈。大多数发作中均联合使用庆大霉素与青霉素或万古霉素（氨基糖苷类药物的平均治疗时长：5周）。接受庆大霉素治疗的患者中，44%出现肾功能不全，且在治疗前血清肌酐水平升高的患者中更常见。我们的结果表明，肠球菌性PVE通常单用抗生素即可成功治疗，并且证实了庆大霉素与细胞壁活性药物联合用于治疗对该药物无高水平耐药性的肠球菌性心内膜炎时的疗效。
