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“心内膜炎团队”的价值。

The value of an "Endocarditis Team".

作者信息

Davierwala Piroze M, Marin-Cuartas Mateo, Misfeld Martin, Borger Michael A

机构信息

University Clinic for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.

出版信息

Ann Cardiothorac Surg. 2019 Nov;8(6):621-629. doi: 10.21037/acs.2019.09.03.

Abstract

Establishment of the Heart Team concept in the field of cardiovascular medicine has resulted in quality improvement in the management of heart valve disease and heart failure. Similarly, the concept of an Endocarditis Team would be important in improving outcomes in patients with infective endocarditis (IE), given it is an uncommon clinical entity with general practitioners and low-volume centers lacking sufficient experience in its management. A multidisciplinary approach can substantially reduce the still unacceptably high morbidity and mortality in patients with IE, as it allows early diagnosis and appropriate comprehensive management. Decision-making within the Endocarditis Team must follow a standard protocol that is based on current clinical guidelines for the management of IE. If surgery is indicated, it is best performed sooner than later in most instances. Communication between referring hospitals and reference centers with an established Endocarditis Team must be smooth and definite protocols for transfer to experienced endocarditis centers with surgical facilities is essential. Follow-up and outpatient care following hospital discharge is crucial due to the possibility of residual infection and risk of development of recurrent endocarditis or heart failure, particularly within the first 2 years. Patient and health-care provider education is the mainstay for the accurate implementation of the Endocarditis Team concept. The following Keynote Lecture offers an overview of the current literature supporting the multidisciplinary management of IE and addresses multiple aspects related to the Endocarditis Team, highlighting its importance and necessity for the comprehensive treatment of this complex disease.

摘要

心血管医学领域中心脏团队概念的建立已使心脏瓣膜病和心力衰竭的管理质量得到改善。同样,鉴于感染性心内膜炎(IE)是一种不常见的临床病症,全科医生和低容量中心在其管理方面缺乏足够经验,心内膜炎团队的概念对于改善IE患者的治疗结果将很重要。多学科方法可以大幅降低IE患者仍然高得令人无法接受的发病率和死亡率,因为它能实现早期诊断和适当的综合管理。心内膜炎团队内部的决策必须遵循基于当前IE管理临床指南的标准方案。如果需要进行手术,在大多数情况下,最好尽早进行。转诊医院与设有心内膜炎团队的参考中心之间的沟通必须顺畅,将患者转至具备手术设施的经验丰富的心内膜炎中心的明确方案至关重要。出院后的随访和门诊护理至关重要,因为存在残余感染以及发生复发性心内膜炎或心力衰竭的风险,尤其是在最初2年内。患者和医疗服务提供者教育是准确实施心内膜炎团队概念的关键。以下主题演讲概述了支持IE多学科管理的当前文献,并探讨了与心内膜炎团队相关的多个方面,强调了其在这种复杂疾病综合治疗中的重要性和必要性。

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本文引用的文献

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Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis.部分口服与静脉抗生素治疗心内膜炎。
N Engl J Med. 2019 Jan 31;380(5):415-424. doi: 10.1056/NEJMoa1808312. Epub 2018 Aug 28.
2
Management of infective endocarditis and multidisciplinary approach.感染性心内膜炎的治疗和多学科方法。
Med Mal Infect. 2019 Feb;49(1):17-22. doi: 10.1016/j.medmal.2018.06.007. Epub 2018 Jul 18.

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