Equipe mobile de microbiologie Clinique, Groupe Hospitalier Paris Saint-Joseph, Paris, France.
Laboratoire de microbiologie clinique, Groupe Hospitalier Paris Saint-Joseph, Paris, France.
Int J Antimicrob Agents. 2019 Jun;53(6):850-854. doi: 10.1016/j.ijantimicag.2019.03.002. Epub 2019 Mar 7.
A variety of microorganisms can cause infective endocarditis (IE), with Staphylococci and Streptococci accounting for the majority of cases. Streptococci are a common cause of community-acquired IE but few studies have focused on this subgroup of endocarditis.
A retrospective multicentre study was conducted between 2012 and 2017 in 12 hospital centres in France. Data were extracted from the local diagnosis-related group database and matched with microbiological results. After identification, the records were retrospectively analysed.
A total of 414 patients with streptococcal endocarditis were included. The patients were predominantly male (72.8%) and the median age was 73.2 years (interquartile range [IQR] 61.3-80.9). The majority of patients (70.6%) had native valve endocarditis. Embolic complications were seen in 38.8% of patients. Viridans group Streptococci (VGS) and bovis-equinus group Streptococci (BGS) accounted for 52.4% and 34.5% of isolated strains, respectively. Minimum inhibitory concentrations (MICs) of amoxicillin were <0.125, 0.125-2 and >2 mg/L for 59.6%, 27% and 1% of isolates, respectively. In-hospital mortality for patients with Streptococci-related IE was 17.8%. In multivariate analysis, the only factor associated with in-hospital mortality was MIC for amoxicillin between 0.25 and 2 mg/L (P = 0.04; OR = 2.23 [95% confidence interval (CI) 1.03-4.88]) whereas performance of cardiac surgery for IE was a protective factor (P = 0.001, OR = 0.23 [95% CI 0.1-0.56]).
IE remains a serious and deadly disease despite recent advances in diagnosis and treatment. Adaptation of antibiotic doses to MICs for amoxicillin and surgery may improve patient outcome.
多种微生物均可引起感染性心内膜炎（IE），其中葡萄球菌和链球菌占大多数病例。链球菌是社区获得性 IE 的常见病因，但很少有研究关注这组亚组的心内膜炎。
2012 年至 2017 年，在法国 12 家医院中心进行了一项回顾性多中心研究。数据从当地诊断相关组数据库中提取，并与微生物学结果相匹配。鉴定后，对记录进行回顾性分析。
共纳入 414 例链球菌心内膜炎患者。患者主要为男性（72.8%），中位年龄为 73.2 岁（四分位距 [IQR] 61.3-80.9）。大多数患者（70.6%）患有原生瓣膜心内膜炎。38.8%的患者发生栓塞并发症。草绿色链球菌（VGS）和牛链球菌（BGS）分别占分离株的 52.4%和 34.5%。阿莫西林的最低抑菌浓度（MIC）<0.125、0.125-2 和>2mg/L 的分离株分别占 59.6%、27%和 1%。链球菌相关 IE 患者的院内死亡率为 17.8%。多变量分析显示，与院内死亡率相关的唯一因素是阿莫西林的 MIC 在 0.25-2mg/L 之间（P=0.04；OR=2.23[95%CI 1.03-4.88]），而 IE 心脏手术是保护因素（P=0.001，OR=0.23[95%CI 0.1-0.56]）。
尽管在诊断和治疗方面取得了进展，但 IE 仍然是一种严重且致命的疾病。调整阿莫西林 MIC 的抗生素剂量和手术可能会改善患者的预后。
