Dunne B, Marr T, Kim D, Andrews D, Edwards M, Merry C, Larbalestier R
Department of Cardiothoracic Surgery, Royal Perth Hospital, Perth, Western Australia, Australia.
Heart Lung Circ. 2014 Jul;23(7):628-35. doi: 10.1016/j.hlc.2014.02.010. Epub 2014 Mar 6.
Infective endocarditis continues to pose a therapeutic challenge to treating clinicians. We believe that the successful management of endocarditis mandates a thorough understanding of the risk factors for adverse outcomes and a co-ordinated team approach.
Between the years 2000 and 2009, 85 patients required surgery for infective endocarditis, with a total of 112 infected valves being treated surgically. Data was analysed to determine factors significantly associated with morbidity and mortality.
The mean age was 50.5 years. Nine (10.5%) of these patients had Prosthetic Valve Endocarditis, the remaining 76 (89.5%) had Native Valve Endocarditis. Twenty-nine percent of patients were NYHA 4 pre-operatively, 15% of patients were haemodynamically unstable requiring inotropic support, 34% were persistently febrile despite antibiotic therapy, and 48% had suffered any embolic event, 20% suffered cerebral emboli. The commonest causative organism in our series was Staphylococcus Aureus (54.1%) with 2.3% of cases being due to MRSA. The second commonest organism isolated was Streptococcus spp. at 21.1%. Operative mortality was 12.9%, of which on-table mortality was 2.2%. Mean follow-up was 56 months (range 1-151). Early recurrence rates (<3 months) were 2.3%. Late recurrence was 7.0%. The pre-operative factors associated with increased mortality were age over 65, inotropic requirement, uncontrolled sepsis and cerebral emboli. We summarise our experience and recommendations for a team approach to the management of infective endocarditis.
感染性心内膜炎仍然给临床治疗医生带来治疗挑战。我们认为，成功管理心内膜炎需要全面了解不良结局的危险因素，并采取协调一致的团队方法。
在2000年至2009年期间，85例患者因感染性心内膜炎需要手术治疗，共112个感染瓣膜接受了手术治疗。对数据进行分析以确定与发病率和死亡率显著相关的因素。
平均年龄为50.5岁。这些患者中有9例（10.5%）患有人工瓣膜心内膜炎，其余76例（89.5%）患有天然瓣膜心内膜炎。29%的患者术前为纽约心脏协会心功能分级4级，15%的患者血流动力学不稳定需要使用血管活性药物支持，34%的患者尽管接受了抗生素治疗仍持续发热，48%的患者发生过任何栓塞事件，20%的患者发生脑栓塞。我们系列中最常见的致病微生物是金黄色葡萄球菌（54.1%），2.3%的病例由耐甲氧西林金黄色葡萄球菌引起。分离出的第二常见微生物是链球菌属，占21.1%。手术死亡率为12.9%，其中术中死亡率为2.2%。平均随访时间为56个月（范围1 - 151个月）。早期复发率（<3个月）为2.3%。晚期复发率为7.0%。与死亡率增加相关的术前因素包括年龄超过6岁、需要血管活性药物、败血症未得到控制和脑栓塞。我们总结了我们在感染性心内膜炎管理团队方法方面的经验和建议。
