Limonta Silvia, Cambau Emmanuelle, Erpelding Marie-Line, Piau-Couapel Caroline, Goehringer François, Plésiat Patrick, Revest Matthieu, Vernet-Garnier Véronique, Moing Vincent Le, Hoen Bruno, Duval Xavier, Tattevin Pierre
Maladies Infectieuses et Reanimation Médicale, Inserm CIC 1414, Hôpital Pontchaillou, Centre Hospitalo-Universitaire, Université Rennes 1, Rennes, France.
UF Urgences Microbiologiques et Mycobactériologie, Département des Agents Infectieux, DMU BioGem APHP-Nord, Hôpital Lariboisière, Université de Paris, Inserm UMR 1137 IAME, Paris, France.
Open Forum Infect Dis. 2020 Apr 13;7(5):ofaa127. doi: 10.1093/ofid/ofaa127. eCollection 2020 May.
Increased access to heart valves through early surgery and progress in molecular microbiology have reduced the proportion of infective endocarditis (IE) with no microbiological documentation and increased the proportion of IE associated with unusual microorganisms.
We performed an ancillary study of a large prospective population-based survey on IE. Unusual-microorganism IE was defined as definite IE (Duke-Li criteria) due to microorganisms other than streptococci, staphylococci, or enterococci.
Of 471 cases of documented IE, 46 (9.8%) were due to unusal microorganisms; the following were involved in >1 case: (n = 4), (n = 4), (n = 3), (n = 3), and (n = 2). Cases were documented with blood cultures (n = 37, 80.4%), heart valve polymerase chain reaction (PCR; n = 5), heart valve culture (n = 2), PCR on vertebral biopsy (n = 1), or serology (n = 1). As compared with IE due to staphylococci, streptococci, or enterococci (n = 420), IE due to unusual microorganisms occurred more frequently in patients with previously known heart disease (69.0% vs 44.3%; = .002), prosthetic valve (40.5% vs 18.1%; = .0006), longer duration of fever (mean, 35.1 ± 46.8 days vs 12.5 ± 17.8; = .003), and who were more often nosocomial (38.1% vs 20.2%; = .02).
In this population-based study, 9.8% of IE cases were due to unusual microorganisms, with a predominance of anaerobes, yeast, and gram-negative bacilli. As compared with IE related to staphylococci, streptococci, or enterococci, IE cases related to unusual microorganisms were associated with previously known heart disease, prosthetic valve, longer duration of fever, and nosocomial acquisition.
ORCID 0000-0003-3617-5411.
早期手术增加了心脏瓣膜的可及性以及分子微生物学的进展，降低了无微生物学记录的感染性心内膜炎（IE）比例，并增加了与不常见微生物相关的IE比例。
我们对一项基于人群的大型IE前瞻性调查进行了一项辅助研究。不常见微生物IE被定义为符合Duke-Li标准的明确IE，病因是链球菌、葡萄球菌或肠球菌以外的微生物。
在471例有记录的IE病例中，46例（9.8%）病因是不常见微生物；以下微生物涉及超过1例：（n = 4），（n = 4），（n = 3），（n = 3），以及（n = 2）。病例通过血培养（n = 37，80.4%）、心脏瓣膜聚合酶链反应（PCR；n = 5）、心脏瓣膜培养（n = 2）、椎体活检PCR（n = 1）或血清学（n = 1）确诊。与由葡萄球菌、链球菌或肠球菌引起的心内膜炎（n = 420）相比，由不常见微生物引起的心内膜炎在已知心脏病患者中更常见（69.0%对44.3%；P = 0.002）、人工瓣膜患者中更常见（40.5%对18.1%；P = 0.0006）、发热持续时间更长（平均35.1±46.8天对12.5±17.8天；P = 0.003），并且医院获得性感染更常见（38.1%对20.2%；P = 0.02）。
在这项基于人群的研究中，9.8%的IE病例病因是不常见微生物，以厌氧菌、酵母菌和革兰氏阴性杆菌为主。与葡萄球菌、链球菌或肠球菌相关的IE相比，与不常见微生物相关的IE病例与已知心脏病、人工瓣膜、更长的发热持续时间和医院获得性感染有关。
ORCID 0000-0003-3617-5411。
