Grace C J, Levitz R E, Katz-Pollak H, Brettman L R
Division of Infectious Disease, Hartford Hospital, Connecticut.
Rev Infect Dis. 1988 Sep-Oct;10(5):922-9. doi: 10.1093/clinids/10.5.922.
Actinobacillus actinomycetemcomitans, a fastidious gram-negative bacillus, has been reported as the cause of prosthetic valve endocarditis in 11 patients. Two additional patients are reported and the literature is reviewed. All cases occurred greater than 1 year after implantation of the prosthesis. Six of the 13 patients had had recent dental work or had poor dentition. Three patients had received endocarditis prophylaxis. Ten of 13 were cured with antibiotics alone. Only one patient suffered from congestive heart failure, and only one had documented evidence of major systemic emboli during antimicrobial therapy. Valve replacement was necessary in only two during antimicrobial therapy. A actinomycetemcomitans should be considered as a possible etiologic agent in late prosthetic valve endocarditis, particularly when blood cultures are initially negative. A regimen of a beta-lactam antibiotic in combination with an aminoglycoside is recommended for 4-6 weeks. The excellent in vitro activity of the third-generation cephalosporins and rifampin promise new therapeutic options.
伴放线放线杆菌是一种苛求性革兰氏阴性杆菌，已有报道称它是11例人工瓣膜心内膜炎的病因。本文报告了另外2例患者并对相关文献进行了综述。所有病例均发生在假体植入1年以后。13例患者中有6例近期接受过牙科治疗或牙列不佳。3例患者接受过心内膜炎预防治疗。13例中有10例仅用抗生素治愈。只有1例患者出现充血性心力衰竭，只有1例在抗菌治疗期间有明确的重大全身性栓塞证据。抗菌治疗期间仅2例需要进行瓣膜置换。伴放线放线杆菌应被视为晚期人工瓣膜心内膜炎的可能病因，尤其是当血培养最初为阴性时。建议使用β-内酰胺抗生素联合氨基糖苷类抗生素的方案治疗4至6周。第三代头孢菌素和利福平出色的体外活性预示着新的治疗选择。
