凝固酶阴性葡萄球菌性心内膜炎的流行病学与预后：万古霉素最低抑菌浓度的影响
Epidemiology and prognosis of coagulase-negative staphylococcal endocarditis: impact of vancomycin minimum inhibitory concentration.
作者信息
García de la Mària Cristina, Cervera Carlos, Pericàs Juan M, Castañeda Ximena, Armero Yolanda, Soy Dolors, Almela Manel, Ninot Salvador, Falces Carlos, Mestres Carlos A, Gatell Jose M, Moreno Asuncion, Marco Francesc, Miró José M
机构信息
Infectious Diseases Service, The Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona School of Medicine, Barcelona, Spain.
Pharmacy Service, The Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona School of Medicine, Barcelona, Spain.
出版信息
PLoS One. 2015 May 11;10(5):e0125818. doi: 10.1371/journal.pone.0125818. eCollection 2015.
This study describes coagulase-negative staphylococcal (CoNS) infective endocarditis (IE) epidemiology at our institution, the antibiotic susceptibility profile, and the influence of vancomycin minimum inhibitory concentration (MIC) on patient outcomes. One hundred and three adults with definite IE admitted to an 850-bed tertiary care hospital in Barcelona from 1995-2008 were prospectively included in the cohort. We observed that CoNS IE was an important cause of community-acquired and healthcare-associated IE; one-third of patients involved native valves. Staphylococcus epidermidis was the most frequent species, methicillin-resistant in 52% of patients. CoNS frozen isolates were available in 88 patients. Vancomycin MICs of 2.0 μg/mL were common; almost all cases were found among S. epidermidis isolates and did not increase over time. Eighty-five patients were treated either with cloxacillin or vancomycin: 38 patients (Group 1) were treated with cloxacillin, and 47 received vancomycin; of these 47, 27 had CoNS isolates with a vancomycin MIC <2.0 μg/mL (Group 2), 20 had isolates with a vancomycin MIC ≥ 2.0 μg/mL (Group 3). One-year mortality was 21%, 48%, and 65% in Groups 1, 2, and 3, respectively (P = 0.003). After adjusting for confounders and taking Group 2 as a reference, methicillin-susceptibility was associated with lower 1-year mortality (OR 0.12, 95% CI 0.02-0.55), and vancomycin MIC ≥ 2.0 μg/mL showed a trend to higher 1-year mortality (OR 3.7, 95% CI 0.9-15.2; P=0.069). Other independent variables associated with 1-year mortality were heart failure (OR 6.2, 95% CI 1.5-25.2) and pacemaker lead IE (OR 0.1, 95%CI 0.02-0.51). In conclusion, methicillin-resistant S.epidermidis was the leading cause of CoNS IE, and patients receiving vancomycin had higher mortality rates than those receiving cloxacillin; mortality was higher among patients having isolates with vancomycin MICs ≥ 2.0 μg/mL.
本研究描述了我院凝固酶阴性葡萄球菌（CoNS）感染性心内膜炎（IE）的流行病学、抗生素敏感性概况，以及万古霉素最低抑菌浓度（MIC）对患者预后的影响。1995年至2008年期间，巴塞罗那一家拥有850张床位的三级护理医院收治的103例确诊IE成年患者被前瞻性纳入该队列研究。我们观察到，CoNS IE是社区获得性和医疗保健相关IE的重要病因；三分之一的患者累及自身瓣膜。表皮葡萄球菌是最常见的菌种，52%的患者对甲氧西林耐药。88例患者有CoNS冷冻分离株。万古霉素MIC为2.0μg/mL很常见；几乎所有病例都在表皮葡萄球菌分离株中发现，且未随时间增加。85例患者接受了氯唑西林或万古霉素治疗：38例患者（第1组）接受氯唑西林治疗，47例接受万古霉素治疗；在这47例患者中，27例CoNS分离株的万古霉素MIC<2.0μg/mL（第2组），20例分离株的万古霉素MIC≥2.0μg/mL（第3组）。第1、2和3组的1年死亡率分别为21%、48%和65%（P = 0.003）。在对混杂因素进行校正并以第2组作为参照后，甲氧西林敏感性与较低的1年死亡率相关（比值比[OR]0.12，95%置信区间[CI]0.02 - 0.55），万古霉素MIC≥2.0μg/mL显示出1年死亡率较高的趋势（OR 3.7，95%CI 0.9 - 15.2；P = 0.069）。与1年死亡率相关的其他独立变量为心力衰竭（OR 6.2，95%CI 1.5 - 25.2）和起搏器电极IE（OR 0.1，95%CI 0.02 - 0.51）。总之，耐甲氧西林表皮葡萄球菌是CoNS IE的主要病因，接受万古霉素治疗的患者死亡率高于接受氯唑西林治疗的患者；万古霉素MIC≥2.0μg/mL的患者死亡率更高。
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