García-Granja Pablo Elpidio, López Javier, Vilacosta Isidre, Ortiz-Bautista Carlos, Sevilla Teresa, Olmos Carmen, Sarriá Cristina, Ferrera Carlos, Gómez Itziar, Román José Alberto San
From the Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario, Valladolid (PEG-G, JL, CO-B, T S, IG, JASR); Hospital Clínico Universitario San Carlos (IV, CO, CF); and Hospital Clínico Universitario la Princesa, Madrid, España (CS).
Medicine (Baltimore). 2015 Dec;94(49):e2000. doi: 10.1097/MD.0000000000002000.
To describe the profile of left-sided polymicrobial endocarditis (PE) and to compare it with monomicrobial endocarditis (ME).Among 1011 episodes of left-sided endocarditis consecutively diagnosed in 3 tertiary centers, between January 1, 1996 and December 31, 2014, 60 were polymicrobial (5.9%), 821 monomicrobial (81.7%), and in 123 no microorganism was detected (12.2%). Seven patients (0.7%) were excluded from the analysis because contamination of biologic tissue could not be discarded. The authors described the clinical, microbiologic, echocardiographic, and outcome of patients with PE and compared it with ME.Mean age was 64 years SD 16 years, 67% were men and 30% nosocomial. Diabetes mellitus (35%) were the most frequent comorbidities, fever (67%) and heart failure (43%) the most common symptoms at admission. Prosthetic valves (50%) were the most frequent infection location and coagulase-negative Staphylococci (48%) and enterococci (37%) the leading etiologies. The most repeated combination was coagulase-negative Staphylococci with enterococci (n = 9). Polymicrobial endocarditis appeared more frequently in patients with underlying disease (70% versus 56%, P = 0.036), mostly diabetics (35% versus 24%, P = 0.044) with previous cardiac surgery (15% versus 8% P = 0.049) and prosthetic valves (50% versus 37%, P = 0.038). Coagulase-negative Staphylococci, enterococci, Gram-negative bacilli, anaerobes, and fungi were more frequent in PE. No differences on age, sex, symptoms, need of surgery, and in-hospital mortality were detected.Polymicrobial endocarditis represents 5.9% of episodes of left-sided endocarditis in our series. Despite relevant demographic and microbiologic differences between PE and ME, short-term outcome is similar.
描述左侧多微生物性心内膜炎（PE）的特征，并将其与单微生物性心内膜炎（ME）进行比较。在1996年1月1日至2014年12月31日期间，3个三级中心连续诊断的1011例左侧心内膜炎病例中，60例为多微生物性（5.9%），821例为单微生物性（81.7%），123例未检测到微生物（12.2%）。7例患者（0.7%）因无法排除生物组织污染而被排除在分析之外。作者描述了PE患者的临床、微生物学、超声心动图表现及预后，并与ME进行了比较。平均年龄为64岁，标准差16岁，67%为男性，30%为医院获得性感染。糖尿病（35%）是最常见的合并症，发热（67%）和心力衰竭（43%）是入院时最常见的症状。人工瓣膜（50%）是最常见的感染部位，凝固酶阴性葡萄球菌（48%）和肠球菌（37%）是主要病因。最常见的组合是凝固酶阴性葡萄球菌与肠球菌（n = 9）。多微生物性心内膜炎在有基础疾病的患者中更常见（70%对56%，P = 0.036），主要是糖尿病患者（35%对24%，P = 0.044），有心脏手术史的患者（15%对8%，P = 0.049）和人工瓣膜患者（50%对37%，P = 0.038）。凝固酶阴性葡萄球菌、肠球菌、革兰氏阴性杆菌、厌氧菌和真菌在PE中更常见。在年龄、性别、症状、手术需求和住院死亡率方面未检测到差异。在我们的系列研究中，多微生物性心内膜炎占左侧心内膜炎病例的5.9%。尽管PE和ME在人口统计学和微生物学方面存在相关差异，但短期预后相似。
