Maor Yasmin, Sternik Leonid, Orlov Boris, Rahav Galia, Keller Nathan, Raanani Ehud, Kogan Alexander
Infectious Disease Unit, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Cardiac Surgery, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Ann Thorac Surg. 2016 Jan;101(1):141-5. doi: 10.1016/j.athoracsur.2015.06.075. Epub 2015 Sep 28.
Q fever is considered endemic worldwide, and endocarditis, or aortic vascular infection, or both caused by Coxiella burnetii can be a fatal disease. The importance of surgical intervention has not yet been defined. We performed a descriptive retrospective study to assess indications for surgical treatment, timing of treatment, and outcome.
We studied all patients from the cardiac surgery department of a large tertiary hospital who underwent valve surgical procedure due to endocarditis or aortic surgical procedure due to graft infection.
Throughout a 10-year period, we performed a total of 171 procedures due to valve endocarditis and/or vascular infection. In 16 patients (9.36%) Coxiella burnetii infection was diagnosed. Ten patients had previous cardiac surgical procedures, 3 had previous aortic surgical procedures, 2 had preexisting valvular disease, and 1 patient had no previous valve disorder. All patients received prolonged oral-specific antibiotic therapy under serologic guidance. In 9 patients antibiotic treatment (doxycycline and hydroxychloroquine) was started before the surgical procedure (12.4 ± 37.5 days), and in 7 patients after the surgical procedure (5.1 ± 13.5 days). We observed one in-hospital death (6.25%) and no long-term mortality. The mean follow-up period was 50.5 ± 34.7 months (range, 2 to 104 months).
In this series surgical treatment yielded good results for both Q fever endocarditis and vascular graft infection. No association was found between timing of the surgical procedure and patients' outcomes.
Q热在全球范围内被认为是地方性疾病，由伯氏考克斯体引起的心内膜炎、主动脉血管感染或两者兼具可能是一种致命疾病。手术干预的重要性尚未明确。我们进行了一项描述性回顾性研究，以评估手术治疗的指征、治疗时机和结果。
我们研究了一家大型三级医院心脏外科所有因心内膜炎接受瓣膜手术或因移植物感染接受主动脉手术的患者。
在10年期间，我们共进行了171例因瓣膜性心内膜炎和/或血管感染的手术。16例患者（9.36%）被诊断为伯氏考克斯体感染。10例患者曾接受过心脏手术，3例曾接受过主动脉手术，2例有瓣膜疾病史，1例患者既往无瓣膜疾病。所有患者在血清学指导下接受了长期口服特异性抗生素治疗。9例患者在手术前开始抗生素治疗（强力霉素和羟氯喹）（12.4±37.5天），7例患者在手术后开始治疗（5.1±13.5天）。我们观察到1例院内死亡（6.25%），无长期死亡率。平均随访期为50.5±34.7个月（范围为2至104个月）。
在本系列研究中，手术治疗对Q热心内膜炎和血管移植物感染均取得了良好效果。未发现手术时机与患者预后之间存在关联。
