Princess Alexandra Hospital, Brisbane, Qld, Australia; Department of Cardiology, Sunshine Coast University Hospital, Brisbane, Qld, Australia; School of Human Movement and Nutrition Studies, The University of Queensland, Brisbane, Qld, Australia.
Princess Alexandra Hospital, Brisbane, Qld, Australia.
Heart Lung Circ. 2020 Jun;29(6):840-850. doi: 10.1016/j.hlc.2019.07.006. Epub 2019 Aug 2.
The epidemiology of infective endocarditis (IE) continues to evolve, with antimicrobial resistance and clinical outcomes largely dependent on the environment of acquisition. This study aimed to provide a contemporary review of the microbiology and antimicrobial management of IE and report echocardiographic findings and predictors of adverse outcomes in community-acquired and health care-associated IE.
Consecutive presentations of IE to a major Australian tertiary referral centre between January 2011 and April 2016 were examined. Culprit organisms and resistance patterns were recorded, as was transthoracic and transoesophageal echocardiography. Real-world antimicrobial prescription and use of an outpatient parenteral antimicrobial therapy (OPAT) service were also assessed, and clinical outcomes analysed.
Of 204 consecutive cases, 30% were associated with health care, a group with a higher burden of comorbidities and more prone to complications. Health care-associated cases had lower rates of surgical intervention but higher mortality. A history of intravenous drug use (IVDU) conferred risk for recurrent IE whereas multivalvular involvement predicted heart failure hospitalisation. Staphylococcus aureus was isolated in 45%. Whilst methicillin resistance remains low, the prevalence of S. aureus IE is increasing. Single antimicrobial agents were commonly used (83%) and therapy via OPAT was safe and significantly reduced length of hospital stay. Not undergoing transoesophageal echocardiography (TOE) or definitive surgical management conferred poorer prognosis.
The epidemiology of IE is evolving and there is need for updated epidemiological data and associated clinical outcomes. Environment of acquisition remains important in the face of increasing health care provision and the changing predominance of culprit microorganisms.
感染性心内膜炎（IE）的流行病学仍在不断发展，抗菌药物耐药性和临床结局在很大程度上取决于感染环境。本研究旨在提供关于 IE 的微生物学和抗菌药物管理的当代综述，并报告社区获得性和医疗保健相关性 IE 的超声心动图发现和不良结局的预测因素。
对 2011 年 1 月至 2016 年 4 月期间澳大利亚一家主要三级转诊中心连续就诊的 IE 患者进行了检查。记录了病原体和耐药模式，以及经胸超声心动图和经食管超声心动图的结果。还评估了真实世界中的抗菌药物处方和使用门诊静脉滴注抗菌药物治疗（OPAT）服务的情况，并分析了临床结局。
204 例连续患者中，30%与医疗保健相关，该组患者合并症负担更高，更容易发生并发症。医疗保健相关性病例手术干预率较低，但死亡率较高。静脉药物使用史（IVDU）增加了复发性 IE 的风险，而多瓣膜受累则预测了心力衰竭住院的风险。45%分离出金黄色葡萄球菌。虽然耐甲氧西林金黄色葡萄球菌的比例仍然较低，但金黄色葡萄球菌 IE 的患病率正在增加。常使用单一抗菌药物（83%），OPAT 治疗是安全的，并显著缩短了住院时间。未进行经食管超声心动图（TOE）或明确的手术治疗预示着预后较差。
IE 的流行病学正在演变，需要更新的流行病学数据和相关的临床结局。在不断增加的医疗保健提供和致病微生物不断变化的优势下，感染环境仍然很重要。
