Salvador Vincent Bryan D, Chapagain Bikash, Joshi Astha, Brennessel Debra J
Tex Heart Inst J. 2017 Feb 1;44(1):10-15. doi: 10.14503/THIJ-15-5359. eCollection 2017 Feb.
Crucial to the management of staphylococcal bacteremia is an accurate evaluation of associated endocarditis, which has both therapeutic and prognostic implications. Because the clinical presentation of endocarditis can be nonspecific, the judicious use of echocardiography is important in distinguishing patients at high risk of developing endocarditis. In the presence of high-risk clinical features, an early transesophageal echocardiogram is warranted without prior transthoracic echocardiography. The purpose of this study was to investigate the clinical risk factors for staphylococcal infective endocarditis that might warrant earlier transesophageal echocardiography and to describe the incidence of endocarditis in cases of methicillin-resistant and methicillin-sensitive Staphylococcus aureus bacteremia. A retrospective case-control study was conducted by means of chart review of 91 patients consecutively admitted to a community hospital from January 2009 through January 2013. Clinical risk factors of patients with staphylococcal bacteremia were compared with risk factors of patients who had definite diagnoses of infective endocarditis. There were 69 patients with bacteremia alone (76%) and 22 patients with endocarditis (24%), as verified by echocardiography. Univariate analysis showed that diabetes mellitus (=0.024), the presence of an automatic implantable cardioverter-defibrillator/pacemaker (=0.006) or a prosthetic heart valve (=0.003), and recent hospitalization (=0.048) were significantly associated with developing infective endocarditis in patients with S. aureus bacteremia. The incidence of methicillin-resistant and methicillin-sensitive S. aureus bacteremia was similar in the bacteremia and infective-endocarditis groups (=0.437). In conclusion, identified high-risk clinical factors in the presence of bacteremia can suggest infective endocarditis. Early evaluation with transesophageal echocardiography might well be warranted.
对葡萄球菌菌血症的管理至关重要的是对相关心内膜炎进行准确评估，这对治疗和预后都有影响。由于心内膜炎的临床表现可能不具有特异性，明智地使用超声心动图对于区分发生心内膜炎高风险患者很重要。在存在高风险临床特征的情况下，无需先进行经胸超声心动图检查，即可早期进行经食管超声心动图检查。本研究的目的是调查可能需要更早进行经食管超声心动图检查的葡萄球菌感染性心内膜炎的临床危险因素，并描述耐甲氧西林和甲氧西林敏感金黄色葡萄球菌菌血症病例中心内膜炎的发生率。通过回顾性病例对照研究，对2009年1月至2013年1月连续入住一家社区医院的91例患者的病历进行了审查。将葡萄球菌菌血症患者的临床危险因素与确诊为感染性心内膜炎患者的危险因素进行了比较。经超声心动图证实，有69例单纯菌血症患者（76%）和22例心内膜炎患者（24%）。单因素分析显示，糖尿病（=0.024）、存在自动植入式心脏复律除颤器/起搏器（=0.006）或人工心脏瓣膜（=0.003）以及近期住院（=0.048）与金黄色葡萄球菌菌血症患者发生感染性心内膜炎显著相关。在菌血症组和感染性心内膜炎组中，耐甲氧西林和甲氧西林敏感金黄色葡萄球菌菌血症的发生率相似（=0.437）。总之，在菌血症存在的情况下确定的高风险临床因素可能提示感染性心内膜炎。可能有必要早期进行经食管超声心动图评估。
