Cleveland Clinic Foundation, Cleveland, USA.
Cleveland Clinic Foundation, Cleveland, USA
Eur Heart J Acute Cardiovasc Care. 2014 Sep;3(3):275-80. doi: 10.1177/2048872614523350. Epub 2014 Feb 12.
Staphylococcus lugdunensis is a coagulase-negative organism that causes a rare but destructive form of infective endocarditis (IE). We sought to evaluate the clinical and echocardiographic profile of S. lugdunensis IE at our institution and compare it to that of Staphylococcus aureus IE.
Utilizing microbiology isolates, we retrospectively reviewed cases of S. lugdunensis bacteraemia admitted to our institution between 2002 and 2011 and included cases that met the modified Duke's criteria and those with device infection. We used univariate analysis to compare the clinical and echocardiographic features and outcomes of these patients with 76 cases of S. aureus IE.
We identified 15 cases of S. lugdunensis IE (10 native, two prosthetic, three device only), amongst whom five cases had underlying structural valvular heart disease. Echocardiography revealed bulky vegetations in 12, abscesses in three, perforation in four, and valve dehiscence in one case. Overall, 7/12 (58%) of valvular IE involved left-sided valves; six of these underwent successful surgical intervention. S. lugdunensis IE resulted in marked valvular destruction similar to S. aureus IE but was more likely to affect patients with prior structural valvular heart disease (42 vs. 7%, p=0.004).
Unlike other coagulase-negative staphylococci, S. lugdunensis causes a rare but destructive form of IE that can involve structurally normal native valves. Echocardiographic imaging is characterized by bulky vegetations and profound valvular destruction similar to that seen with S. aureus IE, thus isolation of this organism in the blood should not be disregarded as a contaminant. Confirmation of left-sided valvular endocarditis warrants surgical intervention.
凝固酶阴性葡萄球菌是一种引起罕见但具破坏性的感染性心内膜炎（IE）的病原体。我们旨在评估本机构中凝固酶阴性葡萄球菌 IE 的临床和超声心动图特征，并将其与金黄色葡萄球菌 IE 进行比较。
我们利用微生物分离株，回顾性分析了 2002 年至 2011 年间我院收治的凝固酶阴性葡萄球菌菌血症患者，并纳入符合改良 Duke 标准和有器械感染的病例。我们采用单变量分析比较了这些患者与 76 例金黄色葡萄球菌 IE 患者的临床和超声心动图特征及结局。
我们确定了 15 例凝固酶阴性葡萄球菌 IE（10 例为原生，2 例为人工，3 例为器械相关），其中 5 例有结构性瓣膜心脏病。超声心动图显示 12 例有大的赘生物，3 例有脓肿，4 例有穿孔，1 例有瓣膜裂开。总体而言，12 例（58%）左心瓣膜受累；其中 6 例接受了成功的手术干预。凝固酶阴性葡萄球菌 IE 导致瓣膜严重破坏，与金黄色葡萄球菌 IE 相似，但更可能影响结构性瓣膜心脏病患者（42% vs. 7%，p=0.004）。
与其他凝固酶阴性葡萄球菌不同，凝固酶阴性葡萄球菌引起一种罕见但具破坏性的 IE，可累及结构正常的原生瓣膜。超声心动图表现为大的赘生物和与金黄色葡萄球菌 IE 相似的严重瓣膜破坏，因此血液中分离出该病原体不应被视为污染菌。确认左侧瓣膜心内膜炎应行手术干预。
