Department of Internal Medicine, Hayama Heart Center, Kanagawa, Japan; Department of General Internal Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan; Unit of Public Health and Preventive Medicine, School of Medicine, Yokohama City University, Kanagawa, Japan.
Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan.
J Infect Chemother. 2020 Jun;26(6):640-642. doi: 10.1016/j.jiac.2020.02.010. Epub 2020 Mar 17.
Inappropriate use of antibiotics without blood cultures could delay diagnosis of infective endocarditis (IE). The pattern of use of antibiotics by primary care physicians who were later diagnosed with IE is unclear. A retrospective cohort study of patients with a definite diagnosis of IE at a community teaching hospital in the Kanagawa prefecture was performed over a 12-year period (2006-2017). Of the 145 patients, 38 patients (26%) had initially attended primary care clinics. The mean age was 63 ± 18 years, and 24 patients (63%) were men. Only one patient (3%) was prescribed antibiotics after obtaining blood cultures. Twenty patients (53%) received antibiotics. Fluoroquinolones (50%) and macrolides (25%) were the most antibiotics prescribed. There were no obvious differences in physicians' specialty between the prescriber and non-prescriber groups. Compared to patients without antibiotic prescription, those prescribed antibiotics had delayed admission and higher mortality (10 vs. 14 days and 11% vs. 30%, respectively). In conclusions, about one-quarter of IE patients initially attended primary care clinics. Of them, about half were inappropriately prescribed antibiotics (without blood cultures obtaining). IE patients receiving inappropriate antibiotics potentially have a worse outcome.
在没有血培养的情况下不合理使用抗生素可能会延迟感染性心内膜炎 (IE) 的诊断。后来被诊断为 IE 的初级保健医生使用抗生素的模式尚不清楚。对神奈川县一家社区教学医院 12 年来（2006-2017 年）确诊为 IE 的患者进行了回顾性队列研究。在 145 例患者中，38 例（26%）最初在初级保健诊所就诊。平均年龄为 63±18 岁，24 例（63%）为男性。只有 1 例（3%）在获得血培养后开了抗生素。20 例（53%）接受了抗生素治疗。氟喹诺酮类（50%）和大环内酯类（25%）是最常开的抗生素。开处方和不开处方组医生的专业之间没有明显差异。与未开抗生素的患者相比，开抗生素的患者住院时间延迟，死亡率更高（分别为 10 天 vs. 14 天和 11% vs. 30%）。总之，约四分之一的 IE 患者最初在初级保健诊所就诊。其中约一半的患者不合理地开了抗生素（没有进行血培养）。接受不合理抗生素治疗的 IE 患者可能预后更差。
