Fitzmaurice Gerard J, McKenna Adrian J, Murphy Jamie, McMullan Ronan, O'Donnell Mark E
Department of Cardiothoracic Surgery, The Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, Northern Ireland, UK,
Gen Thorac Cardiovasc Surg. 2014 Mar;62(3):142-8. doi: 10.1007/s11748-013-0316-3. Epub 2013 Sep 11.
Streptococcus bovis can lead to bacteraemia, septicaemia, and ultimately endocarditis. The objective of this study was to evaluate the long-term implications of S. bovis endocarditis on cardiac morbidity and mortality.
A retrospective cohort study was performed between January 2000 and March 2009 to assess all patients diagnosed with S. bovis bacteraemia from the Belfast Health and Social Care Trust. The primary end-point for cardiac investigations was the presence of endocarditis. Secondary end-points included referral for cardiac surgery and overall mortality.
Sixty-one positive S. bovis blood cultures from 43 patients were included. Following echocardiography, seven patients were diagnosed with infective endocarditis (16.3 % of total patients); four patients (9.3 %) had native valve involvement while three (7.0 %) had prosthetic valve infection. Five of these seven patients had more than one positive S. bovis culture (71.4 %). Three had significant valve dysfunction that warranted surgical repair/replacement, one of whom was unfit for surgery. There was a 100 % recurrence rate amongst the valve replacement patients (n = 2) and six patients with endocarditis had colorectal pathology. Patients with endocarditis had similar long-term survival as those with non-endocarditic bacteraemia (57.1 % alive vs. 50 % of non-endocarditis patients, p = 0.73).
Streptococcus bovis endocarditis patients tended to have pre-existing valvular heart disease and those with prosthetic heart valves had higher surgical intervention and relapse rates. These patients experienced a higher rate of co-existing colorectal pathology but currently have reasonable long-term outcomes. This may suggest that they represent a patient population that merits consideration for an early surgical strategy to maximise long-term results, however, further evaluation is warranted.
牛链球菌可导致菌血症、败血症，并最终引发心内膜炎。本研究的目的是评估牛链球菌心内膜炎对心脏发病率和死亡率的长期影响。
2000年1月至2009年3月间进行了一项回顾性队列研究，以评估贝尔法斯特健康与社会关怀信托基金诊断为牛链球菌菌血症的所有患者。心脏检查的主要终点是心内膜炎的存在。次要终点包括心脏手术转诊和总死亡率。
纳入了43例患者的61份牛链球菌血培养阳性样本。经超声心动图检查后，7例患者被诊断为感染性心内膜炎（占总患者的16.3%）；4例患者（9.3%）为天然瓣膜受累，3例患者（7.0%）为人工瓣膜感染。这7例患者中有5例有不止一次牛链球菌培养阳性（71.4%）。3例有严重瓣膜功能障碍，需要手术修复/置换，其中1例不适合手术。瓣膜置换患者（n = 2）的复发率为100%，6例心内膜炎患者有结直肠病变。心内膜炎患者的长期生存率与非心内膜炎菌血症患者相似（存活者为57.1%，而非心内膜炎患者为50%，p = 0.73）。
牛链球菌心内膜炎患者往往已有瓣膜性心脏病，人工心脏瓣膜患者的手术干预和复发率更高。这些患者并存结直肠病变的发生率较高，但目前的长期预后合理。这可能表明他们是值得考虑早期手术策略以最大化长期结果的患者群体，然而，仍需进一步评估。
