Kaura Amit, Byrne Jonathan, Fife Amanda, Deshpande Ranjit, Baghai Max, Gunning Margaret, Whitaker Donald, Monaghan Mark, MacCarthy Philip A, Wendler Olaf, Dworakowski Rafal
Department of Cardiology and Cardiac Surgery, King's College Hospital NHS Foundation Trust, King's College Hospital, London, UK.
Department of Cardiovascular Medicine, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK.
Open Heart. 2017 Dec 27;4(2):e000699. doi: 10.1136/openhrt-2017-000699. eCollection 2017.
Despite improvements in its management, infective endocarditis (IE) is associated with poor survival. The aim of this study was to evaluate the impact of a multidisciplinary endocarditis team (ET), including a cardiologist, microbiologist and a cardiac surgeon, on the outcome of patients with acute IE according to medical or surgical treatment strategies.
We conducted an observational before-and-after study of 196 consecutive patients with definite IE, who were treated at a tertiary reference centre between 2009 and 2015. The study was divided into two periods: period 1, before the formation of the ET (n=101), and period 2, after the formation of the ET (n=95). The role of the ET included regular multidisciplinary team meetings to confirm diagnosis, inform the type and duration of antibiotic therapy and recommend early surgery, when indicated, according to European guidelines.
The patient demographics and predisposing conditions for IE were comparable between the two study periods. In the time period following the introduction of the ET, there was a reduction in both the time to commencement of IE-specific antibiotic therapy (4.0±4.0 days vs 2.5±3.2 days; P=0.004) and the time from suspected IE to surgery (7.8±7.3 days vs 5.3±4.2 days; P=0.004). A 12-month Kaplan-Meier survival for patients managed medically was 42.9% in the pre-ET period and 66.7% in the post-ET period (P=0.03). The involvement of the ET was a significant independent predictor of 1-year survival in patients managed medically (HR 0.24, 95% CI 0.07 to 0.87; P=0.03).
A standardised multidisciplinary team approach may lead to earlier diagnosis of IE, more appropriate individualised management strategies, expedited surgery, where indicated, and improved survival in those patients chosen for medical management, supporting the recent change in guidelines to recommend the use of a multidisciplinary team in the care of patients with IE.
尽管感染性心内膜炎（IE）的管理有所改善，但其生存率仍较低。本研究旨在根据药物或手术治疗策略，评估包括心脏病专家、微生物学家和心脏外科医生在内的多学科心内膜炎团队（ET）对急性IE患者预后的影响。
我们对2009年至2015年在一家三级参考中心接受治疗的196例确诊IE患者进行了一项前后观察性研究。该研究分为两个阶段：第1阶段，ET成立前（n = 101）；第2阶段，ET成立后（n = 95）。ET的职责包括定期召开多学科团队会议以确诊、告知抗生素治疗的类型和持续时间，并根据欧洲指南在必要时推荐早期手术。
两个研究阶段的患者人口统计学特征和IE的易感因素具有可比性。在引入ET后的时间段内，IE特异性抗生素治疗开始时间（4.0±4.0天对2.5±3.2天；P = 0.004）和从疑似IE到手术的时间（7.8±7.3天对5.3±4.2天；P = 0.004）均有所缩短。接受药物治疗患者的12个月Kaplan-Meier生存率在ET成立前为42.9%，在ET成立后为66.7%（P = 0.03）。ET的参与是接受药物治疗患者1年生存率的显著独立预测因素（HR 0.24，95% CI 0.07至0.87；P = 0.03）。
标准化的多学科团队方法可能导致IE的早期诊断、更合适的个体化管理策略、在必要时加快手术，并改善选择药物治疗患者的生存率，支持最近指南的变化，建议在IE患者的护理中使用多学科团队。
