Burgos Lucrecia M, Cracco Miguel A, Fernández Oses Pablo, Iribarren Ana C, Ronderos Ricardo, Nacinovich Francisco
Instituto Cardiovascular de Buenos Aires (ICBA), Buenos Aires, Argentina. E-mail:
Instituto Cardiovascular de Buenos Aires (ICBA), Buenos Aires, Argentina.
Medicina (B Aires). 2019;79(4):257-264.
The epidemiology of infectious endocarditis (IE) has undergone changes due to a series of factors such as aging, comorbidities and medical procedures. The aim of this study was to evaluate the main clinical, epidemiological and etiological changes of the IE in the last 25 years in Argentina. A comparative analysis of three observational prospective registries was performed in which cases of definite and possible IE were consecutively included according to the Duke criteria: two multicentre studies (EIRA-1 [1992-1994] and EIRA-2 [2001-2002]) and one study in a reference cardiology center (CRC [2007-2017]). In the 1065 episodes of EI evaluated, there were no differences regarding sex, and the patients were older in each period (p < 0.001). Intracardiac device-associated IE was more frequent in the last decade: pacemaker (5.4 vs. 23% p < 0.0001) and prosthetic valve IE (8.5% vs. 19.2% vs. 47.5% p < 0.0001). On the other hand, IE associated with intravenous drugs (P < 0.0001) and congenital heart diseases (p = 0.001) was significantly less frequent. The etiology changed substantially: Streptococcus viridans group decreased (30.8% vs. 26.8% vs. 15.9%, p < 0.001) and IE by Staphylococcus spp. predominated over other microorganisms, with a statistically significant increase in IE due to coagulase-negative Staphylococcus. Surgical treatment was more frequently implemented in the last decade and was accompanied by a trend towards lower mortality in the CRC (23.5%, 24.3% vs. 17.2% p = 0.058).
由于老龄化、合并症和医疗程序等一系列因素，感染性心内膜炎（IE）的流行病学发生了变化。本研究的目的是评估阿根廷过去25年中IE的主要临床、流行病学和病因学变化。对三个观察性前瞻性登记处进行了比较分析，根据杜克标准连续纳入确诊和可能的IE病例：两项多中心研究（EIRA-1[1992-1994]和EIRA-2[2001-2002]）以及一项在参考心脏病中心进行的研究（CRC[2007-2017]）。在评估的1065例EI发作中，性别方面无差异，且各时期患者年龄更大（p<0.001）。心脏内装置相关性IE在过去十年中更为常见：起搏器相关性IE（5.4%对23%，p<0.0001）和人工瓣膜IE（8.5%对19.2%对47.5%，p<0.0001）。另一方面，与静脉药物使用相关的IE（P<0.0001）和先天性心脏病相关的IE（p=0.001）显著减少。病因发生了显著变化：草绿色链球菌组减少（30.8%对26.8%对15.9%，p<0.001），葡萄球菌属导致的IE超过其他微生物，凝固酶阴性葡萄球菌导致的IE有统计学显著增加。过去十年中手术治疗实施得更为频繁，CRC的死亡率有降低趋势（23.5%、24.3%对17.2%，p=0.058）。
