Huang Glen, Gupta Siddhi, Davis Kyle A, Barnes Erin W, Beekmann Susan E, Polgreen Philip M, Peacock James E
Infectious Diseases, Department of Internal Medicine, University of California Los Angeles, Los Angeles, California, USA.
Infectious Diseases, Department of Internal Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA.
Open Forum Infect Dis. 2020 Aug 24;7(9):ofaa342. doi: 10.1093/ofid/ofaa342. eCollection 2020 Sep.
Guidelines exist to aid clinicians in managing patients with infective endocarditis (IE), but the degree of adherence with guidelines by Infectious Disease (ID) physicians is largely unknown.
An electronic survey assessing adherence with selected IE guidelines was emailed to 1409 adult ID physician members of the Infectious Diseases Society of America's Emerging Infections Network.
Five hundred fifty-seven physicians who managed IE responded. Twenty percent indicated that ID was not consulted on every case of IE at their hospitals, and 13% did not recommend transthoracic echocardiography (TTE) for all IE cases. The duration of antimicrobial therapy was timed from the first day of negative blood cultures by 91% of respondents. Thirty-four percent of clinicians did not utilize an aminoglycoside for staphylococcal prosthetic valve IE (PVE). Double β-lactam therapy was "usually" or "almost always" employed by 83% of respondents for enterococcal IE. For patients with active IE who underwent valve replacement and manifested positive surgical cultures, 6 weeks of postoperative antibiotics was recommended by 86% of clinicians.
The finding that adherence was <90% with core guideline recommendations that all patients with suspected IE be seen by ID and that all patients undergo TTE is noteworthy. Aminoglycoside therapy of IE appears to be declining, with double β-lactam regimens emerging as the preferred treatment for enterococcal IE. The duration of postoperative antimicrobial therapy for patients undergoing valve replacement during acute IE is poorly defined and represents an area for which additional evidence is needed.
现有指南可帮助临床医生管理感染性心内膜炎（IE）患者，但传染病（ID）医生对指南的遵循程度很大程度上未知。
一项评估对选定IE指南遵循情况的电子调查通过电子邮件发送给美国传染病学会新发感染网络的1409名成年ID医生成员。
557名管理IE的医生回复了调查。20%表示在其医院并非对每例IE病例都咨询ID，13%未对所有IE病例推荐经胸超声心动图（TTE）检查。91%的受访者对抗菌治疗持续时间从血培养转阴首日开始计时。34%的临床医生对葡萄球菌人工瓣膜心内膜炎（PVE）未使用氨基糖苷类药物。83%的受访者对肠球菌性IE“通常”或“几乎总是”采用双β-内酰胺治疗。对于接受瓣膜置换且手术培养结果呈阳性的活动性IE患者，86%的临床医生推荐术后使用6周抗生素。
值得注意的是，对于所有疑似IE患者应由ID诊治以及所有患者均应接受TTE检查这两条核心指南建议，遵循率均<90%。IE的氨基糖苷类治疗似乎在减少，双β-内酰胺方案正成为肠球菌性IE的首选治疗方法。急性IE期间接受瓣膜置换患者的术后抗菌治疗持续时间定义不明确，是需要更多证据的领域。
