左心细菌性心内膜炎患者（静脉吸毒人群）
Left-sided infective endocarditis in persons who inject drugs.
机构信息
Department of Internal Medicine, Wake Forest Baptist Health, Winston-Salem, NC, 27157, USA.
Department of Pharmacy, Wake Forest Baptist Health, Winston-Salem, NC, 27157, USA.
出版信息
Infection. 2020 Jun;48(3):375-383. doi: 10.1007/s15010-020-01402-x. Epub 2020 Feb 25.
PURPOSE
The purpose of this study was to describe left-sided infective endocarditis (LSIE) in persons who inject drugs (PWID) and compare that group to PWID with non-LSIE and to non-PWID with LSIE.
METHODS
Retrospective single-center study of adult IE patients from 2011 to 2018.
RESULTS
Of the 333 patients in our cohort, 54 were PWID with LSIE, 75 were PWID with non-LSIE, and 204 were non-PWID with LSIE. When comparing LSIE vs non-LSIE in PWID, the LSIE group was older (median age 35 vs 28.5, p < 0.01), had fewer S. aureus infections (59% vs 92%, p < 0.01), was more likely to have cardiac surgery (31% vs 13%, p < 0.01), and had a higher 10-week mortality (22% vs 5%, p < 0.01). When comparing PWID with LSIE to non-PWID with LSIE, the PWID group were younger (median age 35 vs 46, p < 0.01); had more frequent multi-valve involvement (33% vs 19%, p = 0.04), Staphylococcus aureus infections (54% vs 27%, p < 0.01), and previous IE (24% vs 8%, p < 0.01); and experienced more strokes (54% vs 31%, p < 0.01). Ten-week mortality was similar for LSIE in both PWID and non-PWID (24% vs 20%, p = 0.47).
CONCLUSIONS
LSIE in PWID is not uncommon. Compared to non-LSIE in PWID, valve surgery is more common and mortality is higher. For reasons that are unclear, stroke is more frequent in LSIE in PWID than in non-PWID with LSIE but mortality is no different.
目的
本研究旨在描述左心感染性心内膜炎（LSIE）在药物注射者（PWID）中的发病情况，并将其与 PWID 中非 LSIE 患者及非 PWID 中 LSIE 患者进行比较。
方法
回顾性分析 2011 年至 2018 年期间成人 IE 患者的单中心研究。
结果
在我们的队列中，333 例患者中有 54 例为 PWID 合并 LSIE，75 例为 PWID 合并非 LSIE，204 例为非 PWID 合并 LSIE。PWID 中 LSIE 与非 LSIE 相比，LSIE 组年龄较大（中位数年龄 35 岁 vs. 28.5 岁，p<0.01），金黄色葡萄球菌感染较少（59% vs. 92%，p<0.01），更可能接受心脏手术（31% vs. 13%，p<0.01），10 周死亡率较高（22% vs. 5%，p<0.01）。PWID 中 LSIE 与非 PWID 中 LSIE 相比，PWID 组年龄较小（中位数年龄 35 岁 vs. 46 岁，p<0.01）；多瓣膜受累更常见（33% vs. 19%，p=0.04），金黄色葡萄球菌感染更常见（54% vs. 27%，p<0.01），既往 IE 发生率更高（24% vs. 8%，p<0.01）；且发生卒中更常见（54% vs. 31%，p<0.01）。PWID 和非 PWID 中 LSIE 的 10 周死亡率相似（24% vs. 20%，p=0.47）。
结论
PWID 中 LSIE 并不少见。与 PWID 中非 LSIE 相比，PWID 中 LSIE 更常见心脏瓣膜手术，死亡率更高。由于原因不明，PWID 中 LSIE 较非 PWID 中 LSIE 更易发生卒中，但死亡率并无差异。
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