Infectious Diseases Department, Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Crtra Colmenar km 9,1, 28034, Madrid, Spain.
Infection. 2013 Feb;41(1):167-74. doi: 10.1007/s15010-012-0326-6. Epub 2012 Sep 7.
Infective endocarditis (IE) is a severe complication in patients with congenital heart disease (CHD). Epidemiology, etiology, and outcome in this group are different to those of patients with acquired heart disease.
We reviewed all cases of proven and probable IE (Duke's criteria) diagnosed in our center during the last two decades.
We observed 45 cases of IE in patients with CHD (age range 8 months to 35 years); these represented 5.5 % of all the episodes of IE in our institution during the study period. The most frequent CHD were ventricular septal defect (31 %), tetralogy of Fallot (19 %), and atrioventricular septal defect (11 %). Twenty cases of IE (44 %) were recorded in patients with non-corrected native-valve CHD. Of the 24 patients with prosthetic-valve IE, post-operative acquisition during the first 6 months was confirmed in 11 patients (range 4-110 days). IE was community-acquired in 62 % of cases. Streptococcus spp. were the most frequent etiologic agents (33 %), followed by Staphylococcus spp. (32 %). Surgery was required to treat IE in 47 % of patients (52 % in prosthetic-valve IE and 41 % in native-valve IE, p = ns). In comparison to native-valve IE, prosthetic-valve IE was significantly more nosocomial-acquired (61 vs. 14 %, p = 0.002), presented a higher heart failure rate at diagnosis (39 vs. 9 %, p = 0.035), and developed more breakthrough bacteremia episodes (19 vs. 0 %, p = 0.048). Global mortality was 24 % (75 % in patients with prosthetic-valve IE who required surgery and 0 % in patients with native-valve IE who required surgery, p = 0.001). Multivariate analysis excluding breakthrough bacteremia (100 % mortality in this condition) confirmed that nosocomial IE [odds ratio (OR), 23.7; 95 % confidence interval (CI), 2.3-239.9] and the presence of heart failure at diagnosis of IE (OR, 25.9; 95 % CI, 2.5-269.6) were independent factors associated with mortality.
Half of all cases of IE in patients with CHD occurred in patients with non-corrected native-valve CHD and two-thirds were community-acquired. Streptococcus spp. were the most frequent etiological agents. Patients with prosthetic-valve IE present a worse outcome, especially those requiring surgery. Breakthrough bacteremia, nosocomial IE, and heart failure are independent factors of mortality in patients with CHD presenting IE.
感染性心内膜炎（IE）是先天性心脏病（CHD）患者的严重并发症。该组患者的流行病学、病因和预后与获得性心脏病患者不同。
我们回顾了过去 20 年在我们中心诊断的所有明确和可能的 IE（杜克标准）病例。
我们观察到 45 例 CHD 患者发生 IE（年龄 8 个月至 35 岁）；这些患者占研究期间本机构所有 IE 发作的 5.5%。最常见的 CHD 是室间隔缺损（31%）、法洛四联症（19%）和房室间隔缺损（11%）。未纠正的原生瓣膜 CHD 患者中有 20 例（44%）记录了 IE。24 例人工瓣膜 IE 患者中，11 例（4-110 天）术后 6 个月内确诊。62%的 IE 为社区获得性。链球菌属是最常见的病原体（33%），其次是葡萄球菌属（32%）。47%的患者需要手术治疗 IE（人工瓣膜 IE 为 52%，原生瓣膜 IE 为 41%，p=ns）。与原生瓣膜 IE 相比，人工瓣膜 IE 明显更易发生医院获得性感染（61%比 14%，p=0.002），诊断时心力衰竭发生率更高（39%比 9%，p=0.035），且更易发生突破菌血症（19%比 0%，p=0.048）。总死亡率为 24%（需要手术的人工瓣膜 IE 患者为 75%，需要手术的原生瓣膜 IE 患者为 0%，p=0.001）。排除突破菌血症（该情况下死亡率为 100%）的多变量分析证实，医院获得性 IE[比值比（OR），23.7；95%置信区间（CI），2.3-239.9]和 IE 诊断时心力衰竭（OR，25.9；95%CI，2.5-269.6）是与死亡率相关的独立因素。
CHD 患者中一半的 IE 发生在未纠正的原生瓣膜 CHD 患者中，三分之二为社区获得性。链球菌属是最常见的病原体。人工瓣膜 IE 患者的预后更差，尤其是需要手术的患者。突破菌血症、医院获得性 IE 和心力衰竭是 CHD 患者发生 IE 的独立死亡因素。
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