Departments of Cardiology and Cardiac Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Faculty of Medicine and Health, University of Leeds, Leeds, UK.
Eur J Cardiothorac Surg. 2019 Apr 1;55(4):760-765. doi: 10.1093/ejcts/ezy325.
Surgery is often required for acute infective endocarditis (IE) to repair or replace damaged heart valves. Traditionally, long courses of antibiotic treatment have been prescribed after surgery for active IE for fear of infecting newly implanted/repaired valves, but the need for this, in the present era of enhanced antimicrobial stewardship, has been questioned. In our institution, the choice and duration of antimicrobial therapy is tailored to individual patients by a multidisciplinary team with an interest in IE. The influence of the duration of postoperative antibiotic therapy on outcomes was studied in patients requiring surgery prior to the completion of a planned course of antibiotic therapy.
This was a retrospective observational study on patients with acute IE requiring surgery between January 2004 and December 2015. The primary outcome was relapse. Secondary outcomes were early reoperation and 1-year mortality.
In total, 182 IE episodes were included in the final analysis. The median duration of postoperative antibiotic therapy was 23.5 days (interquartile range 12-40 days) and decreased significantly during the period of study (P < 0.001). There were 2 relapses (1.1%) and 18 (9.9%) postoperative deaths within 1 year. Nine (5%) patients underwent early reoperation. The duration of postoperative antibiotic therapy did not affect either the primary or the secondary outcomes.
This work supports previous findings that selected patients who require surgery during active IE can be safely given shorter courses of postoperative antibiotics without an impact on relapse of infection or survival.
对于急性感染性心内膜炎（IE），手术常常是必需的，以修复或替换受损的心脏瓣膜。传统上，为了防止感染新植入/修复的瓣膜，在手术后的 IE 活动期，会开具长疗程的抗生素治疗，但在当前强化抗菌药物管理时代，这种做法的必要性受到了质疑。在我们的机构中，由对 IE 感兴趣的多学科团队根据个体患者的情况选择和调整抗生素治疗的方案和疗程。本研究旨在探讨手术前未完成计划疗程的抗生素治疗的 IE 患者，术后抗生素治疗的持续时间对结局的影响。
这是一项回顾性观察研究，纳入了 2004 年 1 月至 2015 年 12 月期间需要手术的急性 IE 患者。主要结局为复发。次要结局为早期再次手术和 1 年死亡率。
共有 182 例 IE 发作纳入最终分析。术后抗生素治疗的中位疗程为 23.5 天（四分位间距 12-40 天），且在研究期间显著缩短（P < 0.001）。术后 1 年内有 2 例（1.1%）复发和 18 例（9.9%）死亡。9 例（5%）患者进行了早期再次手术。术后抗生素治疗的疗程并不影响主要或次要结局。
本研究结果支持既往研究发现，对于需要在 IE 活动期手术的选定患者，可以安全地给予较短疗程的术后抗生素治疗，而不会影响感染复发或生存。
