Ambrosioni J, Hernandez-Meneses M, Téllez A, Pericàs J, Falces C, Tolosana J M, Vidal B, Almela M, Quintana E, Llopis J, Moreno A, Miro José M
Infectious Diseases Service, Hospital Clinic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
Cardiology Service, Hospital Clinic, University of Barcelona, Barcelona, Spain.
Curr Infect Dis Rep. 2017 May;19(5):21. doi: 10.1007/s11908-017-0574-9.
Infective endocarditis (IE) is a relatively infrequent infectious disease. It does, however, causes serious morbidity, and its mortality rate has remained unchanged at approximately 25%. Changes in IE risk factors have deeply impacted its epidemiology during recent decades but literature from low-income countries is very scarce. Moreover, prophylaxis guidelines have recently changed and the impact on IE incidence is still unknown.
In high-income countries, the proportion of IE related to prior rheumatic disease has decreased significantly and has been replaced proportionally by cases related to degenerative valvulopathies, prosthetic valves, and cardiovascular implantable electronic devices. Nosocomial and non-nosocomial-acquired cases have risen, as has the proportion caused by staphylococci, and the median age of patients. In low-income countries, in contrast, rheumatic disease remains the main risk factor, and streptococci the most frequent causative agents. Studies performed to evaluate impact of guidelines changes' have shown contradictory results. The increased complexity of cases in high-income countries has led to the creation of IE teams, involving several specialties. New imaging and microbiological techniques may increase sensitivity for diagnosis and detection of IE cases. In low-income countries, IE remained related to classic risk factors. The consequences of prophylaxis guidelines changes are still undetermined.
感染性心内膜炎（IE）是一种相对罕见的传染病。然而，它会导致严重的发病情况，其死亡率一直保持在约25%不变。近几十年来，IE危险因素的变化对其流行病学产生了深刻影响，但来自低收入国家的文献非常稀少。此外，预防指南最近有所变化，对IE发病率的影响仍不清楚。
在高收入国家，与既往风湿性疾病相关的IE比例显著下降，取而代之的是与退行性瓣膜病、人工瓣膜和心血管植入式电子设备相关的病例按比例增加。医院获得性和非医院获得性病例均有所上升，葡萄球菌引起的病例比例以及患者的中位年龄也有所上升。相比之下，在低收入国家，风湿性疾病仍然是主要危险因素，链球菌是最常见的病原体。为评估指南变化影响而进行的研究结果相互矛盾。高收入国家病例复杂性的增加导致了IE团队的组建，涉及多个专业。新的影像学和微生物学技术可能会提高IE病例诊断和检测的敏感性。在低收入国家，IE仍然与经典危险因素相关。预防指南变化的后果仍未确定。
