瓣膜培养物对活动性左侧感染性心内膜炎预后的影响。
Impact of Valve Culture in the Prognosis of Active Left-sided Infective Endocarditis.
机构信息
Instituto de Ciencias del Corazón, Hospital Clínico Universitario Valladolid, Spain.
Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain.
出版信息
Clin Infect Dis. 2019 Mar 5;68(6):1017-1023. doi: 10.1093/cid/ciy684.
BACKGROUND
The culture of removed cardiac tissues during cardiac surgery of left-sided infective endocarditis (LSIE) helps to guide antibiotic treatment. Nevertheless, the prognostic information of a positive valve culture has never been explored.
METHODS
Among 1078 cases of LSIE consecutively diagnosed in 3 tertiary centers, we selected patients with positive blood cultures who underwent surgery during the active period of infection and in whom surgical biological tissues were cultured (n = 429). According to microbiological results, we constructed 2 groups: negative valve culture (n=218) and concordant positive valve culture (CPVC) (n=118). We compared their main features and performed a multivariable analysis of in-hospital mortality.
RESULTS
Patients with CPVC presented more nosocomial origin (32% vs 20%, P = .014), more septic shock (21% vs 11%, P = .007), and higher Risk-E score (29% vs 21%, P = .023). Their in-hospital mortality was higher (35% vs 19%, P = .001), despite an earlier surgery (3 vs 11 days from antibiotic initiation, P < .001). Staphylococcus species (61% vs 42%, P = .001) and Enterococcus species (20% vs 9%, P = .002) were more frequent in the CPVC group, whereas Streptococcus species were less frequent (14% vs 42%, P < .001). Independent predictors for in-hospital mortality were renal failure (odds ratio [OR], 2.6 [95% confidence interval {CI}, 1.5-4.4]), prosthesis (OR, 1.9 [95% CI, 1.1-3.5]), Staphylococcus aureus (OR, 1.8 [95% CI, 1.02-3.3]), and CPVC (OR, 2.3 [95% CI, 1.4-3.9]).
CONCLUSIONS
Valve culture in patients with active LSIE is an independent predictor of in-hospital mortality.
背景
左心感染性心内膜炎（LSIE）心外科手术中切除的心组织培养有助于指导抗生素治疗。然而，阳性瓣膜培养的预后信息从未被探索过。
方法
在 3 家三级中心连续诊断的 1078 例 LSIE 患者中，我们选择了阳性血培养、感染活跃期手术且手术生物组织培养的患者（n=429）。根据微生物学结果，我们构建了 2 个组：阴性瓣膜培养（n=218）和一致性阳性瓣膜培养（CPVC）（n=118）。我们比较了它们的主要特征，并进行了院内死亡率的多变量分析。
结果
CPVC 组患者更倾向于医院获得性感染（32% vs 20%，P=.014），更易发生感染性休克（21% vs 11%，P=.007），风险评分（E 评分）更高（29% vs 21%，P=.023）。尽管手术更早（抗生素开始后 3 天 vs 11 天，P<0.001），但 CPVC 组的院内死亡率更高（35% vs 19%，P=.001）。CPVC 组中金黄色葡萄球菌（61% vs 42%，P=.001）和肠球菌（20% vs 9%，P=.002）更为常见，而链球菌则较少见（14% vs 42%，P<0.001）。院内死亡率的独立预测因素包括肾功能衰竭（比值比 [OR]，2.6[95%置信区间 {CI}，1.5-4.4]）、假体（OR，1.9[95% CI，1.1-3.5]）、金黄色葡萄球菌（OR，1.8[95% CI，1.02-3.3]）和 CPVC（OR，2.3[95% CI，1.4-3.9]）。
结论
在活动性 LSIE 患者中，瓣膜培养是院内死亡率的独立预测因素。
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