Fukuchi Takahiko, Iwata Kentaro, Ohji Goh
From the Division of Infectious Diseases therapeutics, Department of Microbiology and Infectious Diseases, Kobe University Graduate School of Medicine, Kobe, Japan.
Medicine (Baltimore). 2014 Dec;93(27):e237. doi: 10.1097/MD.0000000000000237.
Infective endocarditis (IE) is a severe disease with high morbidity and mortality, and these can be exacerbated by delay in diagnosis. We investigated IE diagnosis in Japan with the emphasis on the delay in diagnosis and its cause and implications. We conducted a retrospective study on 82 definite IE patients at Kobe University Hospital from April 1, 2008, through March 31, 2013. We reviewed charts of the patients for data such as causative pathogens, prescription of inappropriate antibiotic use prior to the diagnosis, existence of risk factors of IE, previous doctor's subspecialty, or duration until the diagnosis, with the primary outcome of 180-day mortality. We also qualitatively, as well as quantitatively, analyzed those cases with delay in diagnosis, and hypothesized its causes and implications. Eighty-two patients were reviewed for this analysis. The average age was 61 ± 14.5-year-old. Fifty percent of patients had known underlying risk factors for IEs, such as prosthetic heart valve (10), valvular heart disease (21), congenital heart disease (3), or cardiomyopathy (2). The median days until the diagnosis was 14 days (range 2 days to 1 year). Sixty-five percent of patients received inappropriate antibiotic before the diagnosis (53). Forty percent of causative organisms were Staphylococcus aureus (MSSA 20, MRSA 13), 32% were viridans streptococci and Streptococcus bovis, 28% were others or unknown (CNS 5, Corynebacterium 3, Cardiobacterium 1, Candida 1). Subspecialties such as General Internal Medicine (15), and Orthopedics (13) were associated with delay in diagnosis. Ten patients (12%) died during follow up, and 8 of them had been received prior inappropriate antibiotics. Significant delay in the diagnosis of IE was observed in Japan. Inappropriate antibiotics were prescribed frequently and may be associated with poor prognosis. Further improvement for earlier diagnosis of IE is needed.
感染性心内膜炎（IE）是一种发病率和死亡率都很高的严重疾病，而诊断延迟会加剧这些情况。我们以诊断延迟及其原因和影响为重点，对日本的IE诊断情况进行了调查。我们对2008年4月1日至2013年3月31日期间在神户大学医院确诊的82例IE患者进行了一项回顾性研究。我们查阅了患者的病历，以获取诸如致病病原体、诊断前不适当使用抗生素的处方、IE的危险因素的存在情况、之前医生的亚专业或诊断所需时间等数据，主要结局指标为180天死亡率。我们还对诊断延迟的病例进行了定性和定量分析，并推测其原因和影响。本次分析共纳入82例患者。平均年龄为61±14.5岁。50%的患者已知存在IE的潜在危险因素，如人工心脏瓣膜（10例）、心脏瓣膜病（21例）、先天性心脏病（3例）或心肌病（2例）。诊断所需的中位天数为14天（范围为2天至1年）。65%的患者在诊断前接受了不适当的抗生素治疗（53例）。40%的致病微生物为金黄色葡萄球菌（甲氧西林敏感金黄色葡萄球菌20例，耐甲氧西林金黄色葡萄球菌13例），32%为草绿色链球菌和牛链球菌，28%为其他或不明（凝固酶阴性葡萄球菌5例，棒状杆菌3例，心杆菌1例，念珠菌1例）。普通内科（15例）和骨科（13例）等亚专业与诊断延迟有关。10例患者（12%）在随访期间死亡，其中8例之前接受过不适当的抗生素治疗。在日本观察到IE诊断存在显著延迟。不适当的抗生素处方频繁，可能与预后不良有关。需要进一步改进以更早诊断IE。
