Département de Cardiologie, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France; Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), CNRS UMR 6236, Faculté de Médecine, Aix-Marseille University, Marseille, France.
Département de Chirurgie Cardiaque, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France.
Lancet. 2012 Mar 10;379(9819):965-975. doi: 10.1016/S0140-6736(11)60755-1. Epub 2012 Feb 7.
Despite improvements in medical and surgical therapies, infective endocarditis is associated with poor prognosis and remains a therapeutic challenge. Many factors affect the outcome of this serious disease, including virulence of the microorganism, characteristics of the patients, presence of underlying disease, delays in diagnosis and treatment, surgical indications, and timing of surgery. We review the strengths and limitations of present therapeutic strategies and propose future directions for better management of endocarditis according to the most recent research. Novel perspectives on the management of endocarditis are emerging and offer hope for decreasing the rate of residual deaths by accelerating the process of diagnosis and risk stratification, reducing delays in starting antimicrobial therapy, rapid transfer of high-risk patients to specialised medico-surgical centres, development of new surgical methods, and close long-term follow-up.
尽管在医学和外科治疗方面有所进步，但感染性心内膜炎的预后仍然较差，仍是一项治疗挑战。许多因素影响这种严重疾病的结局，包括微生物的毒力、患者的特征、基础疾病的存在、诊断和治疗的延迟、手术适应证以及手术时机。我们回顾了目前治疗策略的优缺点，并根据最新的研究提出了更好地管理心内膜炎的未来方向。心内膜炎管理的新观点正在出现，并有望通过加速诊断和风险分层过程、减少开始抗菌治疗的延迟、将高危患者迅速转移到专门的医学外科中心、开发新的手术方法以及密切的长期随访来降低残余死亡率。
