Peat E B, Lang S D
Middlemore Hospital, Otahuhu, Auckland.
N Z Med J. 1989 Feb 8;102(861):33-6.
Over a 10 year period, 78 cases of infective endocarditis were seen at a general hospital serving a multiracial community. There was a bimodal distribution by age and by race. Rheumatic heart disease was a predisposing factor in 45% of cases and was particularly common in young Polynesians. Only eight patients had undergone procedures which might have caused bacteraemia. Most cases were due to streptococci (67%) or staphylococci (27%). Eighteen of 78 patients (23%) died in hospital, usually as a result of overwhelming sepsis or neurological complications. The 60 discharged have been followed for an average of almost three years. There have been 11 deaths but only two related to the previous endocarditis. Three of 41 patients infected with viridans streptococci died. There were no relapses and only one microbiological failure due to these organisms. All 14 patients with viridans streptococcal endocarditis treated with combined therapy for two weeks were cured. Ten of 16 cases of Staph aureus endocarditis were fatal. All but one involved the left side of the heart. The series included no intravenous drug abusers. Sixteen cases of endocarditis involved prosthetic valves and in this group the mortality, frequency of complications and need for surgery were significantly more frequent than in those with native valve infection.
在10年期间，一家为多种族社区服务的综合医院共收治了78例感染性心内膜炎患者。其年龄分布和种族分布呈双峰状。风湿性心脏病是45%病例的诱发因素，在年轻的波利尼西亚人中尤为常见。只有8名患者曾接受过可能导致菌血症的手术。大多数病例由链球菌（67%）或葡萄球菌（27%）引起。78名患者中有18名（23%）在医院死亡，通常是由于严重败血症或神经系统并发症。60名出院患者平均随访了近三年。已有11人死亡，但只有两例与先前的心内膜炎有关。41例感染草绿色链球菌的患者中有3人死亡。这些病菌没有复发，只有1例微生物治疗失败。所有14例接受联合治疗两周的草绿色链球菌性心内膜炎患者均治愈。16例金黄色葡萄球菌性心内膜炎中有10例死亡。除1例外，所有病例均累及心脏左侧。该系列病例中没有静脉注射毒品者。16例心内膜炎涉及人工瓣膜，与天然瓣膜感染患者相比，该组患者的死亡率、并发症发生率和手术需求明显更高。
