Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor.
Division of Hospital Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor.
Am J Med. 2020 Jan;133(1):44-49. doi: 10.1016/j.amjmed.2019.08.022. Epub 2019 Sep 12.
Infectious endocarditis is a highly morbid disease with approximately 43,000 cases per year in the United States. The modified Duke Criteria have poor sensitivity; however, advances in diagnostic imaging provide new tools for clinicians to make what can be an elusive diagnosis. There are a number of risk stratification calculators that can help guide providers in medical and surgical management. Patients who inject drugs pose unique challenges for the health care system as their addiction, which is often untreated, can lead to recurrent infections after valve replacement. There is a need to increase access to medication-assisted treatment for opioid use disorders in this population. Recent studies suggest that oral and depo antibiotics may be viable alternatives to conventional intravenous therapy. Additionally, shorter courses of antibiotic therapy are potentially equally efficacious in patients who are surgically managed. Given the complexities involved with their care, patients with endocarditis are best managed by multidisciplinary teams.
感染性心内膜炎是一种高度致命的疾病，美国每年约有 43000 例。改良的杜克标准敏感性较差；然而，诊断成像的进步为临床医生提供了新的工具来做出可能难以捉摸的诊断。有许多风险分层计算器可以帮助提供者在医疗和手术管理中进行指导。注射毒品的患者给医疗系统带来了独特的挑战，因为他们的成瘾往往未得到治疗，这可能导致瓣膜置换后反复感染。需要增加药物辅助治疗阿片类药物使用障碍的机会。最近的研究表明，口服和 depot 抗生素可能是传统静脉治疗的可行替代品。此外，在接受手术治疗的患者中，较短疗程的抗生素治疗可能同样有效。鉴于他们的护理涉及到复杂性，感染性心内膜炎患者最好由多学科团队管理。
