Gupta Ashish, Gupta Anu, Kaul Upendra, Varma Amit
Depatment of Critical Care Medicine, Fortis Escorts Heart Institute, Okhla Road, New Delhi, India.
Indian J Crit Care Med. 2013 May;17(3):140-7. doi: 10.4103/0972-5229.117041.
The clinical profile of infective endocarditis (IE) has been continuously evolving over last 3-4 decades as highlighted by many studies from developed world.
To evaluate the recent changes in the spectrum and clinical profile, and outcome of IE in an Indian setup.
This was a descriptive, cross-sectional study. Demographic, clinical, characteristics, treatment, and outcome were examined in 'definite' cases of IE admitted at our institute between July 2005 and December 2010.
61 'definite' cases were identified. Mean patient age was 49.3 ± 13.7 years. Male to female ratio was 3.3:1. Rheumatic heart disease was the underlying heart disease in 23 (37.7%) patients. 33 (54.1%) patients had already received antibiotic therapy before presentation to us. Blood cultures were positive in 41 (67.2%) patients. Streptococci and staphylococci were the commonest microbial isolates, 9 (21.4%) patients each. Transesophageal echocardiography (TEE) was done for all the patients. Vegetations were detected in 54 (88%) patients. Surgery was done in 30 (49.2%) patients. In-hospital mortality happened in 4 (6.5%) patients.
WE RECORDED SEVERAL NEW TRENDS, LIKE: 1) an increasing age, 2) an increasing proportion of patients with no previously known heart disease, 3) improving culture positivity rates, 4) rise in staphylococcal infections, 5) increased usage of TEE, 6) high elective surgical rate, and 7) apparent improved survival rates. These changes point to the fact that 'modern era' changes in the profile of IE have started to appear in a selected population in India.
正如发达国家的许多研究所强调的，在过去三四十年中，感染性心内膜炎（IE）的临床特征一直在不断演变。
评估印度地区IE的疾病谱、临床特征及近期变化和结局。
这是一项描述性横断面研究。对2005年7月至2010年12月在我院收治的“确诊”IE患者的人口统计学、临床特征、治疗及结局进行了检查。
共确定61例“确诊”病例。患者平均年龄为49.3±13.7岁。男女比例为3.3:1。23例（37.7%）患者的基础心脏病为风湿性心脏病。33例（54.1%）患者在来我院就诊前已接受过抗生素治疗。41例（67.2%）患者血培养呈阳性。链球菌和葡萄球菌是最常见的分离微生物，各有9例（21.4%）。所有患者均进行了经食管超声心动图（TEE）检查。54例（88%）患者检测到赘生物。30例（49.2%）患者接受了手术。4例（6.5%）患者在住院期间死亡。
我们记录到了一些新趋势，比如：1）年龄增加；2）既往无心脏病史的患者比例增加；3）培养阳性率提高；4）葡萄球菌感染增加；5）TEE使用增加；6）择期手术率高；7）生存率明显提高。这些变化表明，IE特征的“现代”变化已开始在印度特定人群中出现。
