新兴 C 群和 G 群链球菌性心内膜炎：加拿大视角。

Emerging group C and group G streptococcal endocarditis: A Canadian perspective.

机构信息

Section of Internal Medicine, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, BMSB 507, Department of Medical Microbiology, 745 Bannatyne Ave, Winnipeg, Manitoba R3E0J9, Canada.

Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, St. Boniface General Hospital, 409 Taché Avenue, Winnipeg, Manitoba R2H2A6, Canada.

出版信息

Int J Infect Dis. 2017 Dec;65:128-132. doi: 10.1016/j.ijid.2017.10.018. Epub 2017 Oct 31.

DOI:10.1016/j.ijid.2017.10.018

PMID:29097247

Abstract

OBJECTIVES

The aim of this study was to determine the incidence of infective endocarditis (IE) in patients with bacteremia caused by group C and group G streptococci (GCGS) and to characterize the burden of disease, clinical characteristics, and outcomes through a case series of patients with GCGS IE.

METHODS

Individuals with blood cultures growing GCGS in Manitoba, Canada, between January 2012 and December 2015 were included. Clinical and echocardiographic parameters were collected retrospectively. IE was suspected or confirmed according to the modified Duke criteria.

RESULTS

Two hundred and nine bacteremic events occurred in 198 patients. Transthoracic echocardiography (TTE) was performed in 33%. Suspected or confirmed IE occurred in 6% of all patients and in 18% of those with TTE. Native valve infection was more common than prosthetic valve and device-related infections (75%, 17%, and 8%, respectively). Metastatic infection was observed in 64%, primarily to the lungs (57%), skin (43%), osteoarticular system (29%), and central nervous system (29%). Sepsis occurred in 58% and streptococcal toxic shock syndrome in 50% of those with IE, with overall mortality of 17%.

CONCLUSIONS

IE from GCGS bacteremia is common and is frequently associated with severe disease, embolic events, and mortality. In the appropriate clinical context, GCGS bacteremic events should prompt investigation for IE.

摘要

目的

本研究旨在确定由 C 群和 G 群链球菌（GCGS）引起菌血症患者中感染性心内膜炎（IE）的发生率，并通过 GCGS IE 患者的病例系列来描述疾病负担、临床特征和结局。

方法

纳入 2012 年 1 月至 2015 年 12 月期间在加拿大马尼托巴省发生 GCGS 菌血症的个体。回顾性收集临床和超声心动图参数。根据改良的 Duke 标准怀疑或确诊 IE。

结果

198 名患者发生了 209 次菌血症事件。33%的患者进行了经胸超声心动图（TTE）检查。所有患者中 6%和 TTE 检查患者中 18%怀疑或确诊为 IE。原发性瓣膜感染比人工瓣膜和器械相关感染更为常见（分别为 75%、17%和 8%）。64%的患者发生转移性感染，主要累及肺部（57%）、皮肤（43%）、骨关节炎系统（29%）和中枢神经系统（29%）。58%的 IE 患者发生败血症，50%的患者发生链球菌中毒性休克综合征，总死亡率为 17%。