超声心动图在金黄色葡萄球菌血症中诊断天然瓣膜感染性心内膜炎的临床应用价值

Clinical utility of echocardiography for the diagnosis of native valve infective endocarditis in Staphylococcus aureus bacteremia.

作者信息

Lau Lawrence, Wiens Evan J, Karlowsky James A, Keynan Yoav, Jassal Davinder S

机构信息

Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.

Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.

出版信息

Echocardiography. 2019 Oct;36(10):1852-1858. doi: 10.1111/echo.14480. Epub 2019 Sep 19.

DOI:10.1111/echo.14480

PMID:31536152

Abstract

BACKGROUND

The incidence of Staphylococcus aureus infective endocarditis (IE) is steadily rising due to advances in health care delivery. Routine echocardiography is essential in the management of Staphylococcus aureus bacteremia (SAB). The aim of this retrospective cohort study was to characterize the real-world use of echocardiography in adult patients with SAB and native valve S aureus IE.

METHODS

Using an academic hospital microbiological database, all cases of SAB in adults between 2010 and 2016 were identified. Demographic, echocardiographic, and clinical features were recorded.

RESULTS

A total of 738 episodes of SAB were identified, of which 504 (68%) patients underwent transthoracic echocardiography (TTE) within 30 days. Of 73 patients with definite IE, 46 (63%) patients had definite IE diagnosed on the initial TTE. An additional 14 (19%) patients had definite IE diagnosed on repeat TTE, 6 (8%) on transesophageal echocardiography (TEE), and 7 (10%) were diagnosed without fulfilling Duke echocardiographic criteria. The yield of repeat TTE was comparable to that of TEE for identifying new vegetations not identified on the initial TTE (17% vs 21%, P = .78).

CONCLUSIONS

Most cases of IE in SAB were identified using TTE alone, with repeat TTE improving the diagnostic yield in the setting of clinical decompensation.

摘要

背景

由于医疗保健服务的进步，金黄色葡萄球菌感染性心内膜炎（IE）的发病率正在稳步上升。常规超声心动图检查对于金黄色葡萄球菌血症（SAB）的管理至关重要。这项回顾性队列研究的目的是描述超声心动图在成年SAB患者和天然瓣膜金黄色葡萄球菌IE患者中的实际应用情况。

方法

利用一家学术医院的微生物学数据库，确定了2010年至2016年间所有成年SAB病例。记录了人口统计学、超声心动图和临床特征。

结果

共确定了738例SAB发作，其中504例（68%）患者在30天内接受了经胸超声心动图（TTE）检查。在73例确诊为IE的患者中，46例（63%）在初次TTE检查时被确诊为IE。另外14例（19%）患者在重复TTE检查时被确诊为IE，6例（8%）在经食管超声心动图（TEE）检查时被确诊，7例（10%）在未满足杜克超声心动图标准的情况下被确诊。重复TTE检查在识别初次TTE检查未发现的新赘生物方面的检出率与TEE相当（17%对21%，P = 0.78）。