Department of Cardiovascular Surgery, CHU Liege, Belgium.
Department of Anesthesiology, CHU Liege, Belgium.
J Infect Public Health. 2020 Nov;13(11):1705-1709. doi: 10.1016/j.jiph.2020.09.010. Epub 2020 Oct 11.
Staphylococcus capitis (S. capitis) is a subtype of coagulase-negative staphylococci and a commensal of the skin of the human scalp and forehead. S. capitis has been occasionally reported in infective endocarditis and rarely in prosthetic valve endocarditis (PVE). The purpose of this report is to present the clinical course and the surgical management of a series of four patients with S. capitis PVE.
The medical records of 190 adult patients with a definite diagnosis of infective endocarditis by the Duke modified criteria and who underwent surgery at our center between January 2008 and December 2018 were retrospectively reviewed.
There were four cases of S. capitis infective endocarditis among 190 patients. All were male with an average age of 70.25 years (range, 58-80 years). The four cases were PVE: 3 aortic (1 mechanical and 2 biological bioprostheses) and 1 mitral (bioprosthesis). Their mean Euroscore II was 32.43 (range, 9.19-50.8). Three patients had underlying diseases (diabetes mellitus=2, chronic obstructive pulmonary disease=3, chronic kidney disease=1, peripheral arterial disease=2, ischemic heart disease=1, dilated cardiomyopathy=1). Preoperative clinical presentation was characterized by the occurrence of sepsis in three patients and heart failure and sepsis in one patient. Two patients presented with vegetation (mitral bioprosthesis, aortic bioprosthesis). A prosthetic dehiscence was present in all patients, and two presented with a localized annular abscess. All but one patient received triple antibiotic treatment with vancomycin plus rifampicin plus gentamycin. Surgery was performed on an urgent basis in all patients, and the in-hospital mortality rate was 50%.
While limited by the small number of patients, our series highlights the aggressive clinical course of S. capitis PVE with a mortality rate close to that of Staphylococcus aureus PVE. Therefore, early surgical management is recommended to improve the clinical outcome of this serious disease.
头葡萄球菌（S. capitis）是凝固酶阴性葡萄球菌的一个亚型，是人类头皮和额头皮肤的共生菌。头葡萄球菌偶尔会在感染性心内膜炎中报告，在人工瓣膜心内膜炎（PVE）中很少见。本报告的目的是介绍四例头葡萄球菌 PVE 患者的临床经过和手术治疗。
回顾性分析 2008 年 1 月至 2018 年 12 月期间在我院接受手术治疗的 190 例经 Duke 改良标准明确诊断为感染性心内膜炎的成人患者的病历。
在 190 例患者中，有 4 例头葡萄球菌感染性心内膜炎。均为男性，平均年龄 70.25 岁（范围，58-80 岁）。4 例均为 PVE：3 例主动脉（1 例机械瓣和 2 例生物瓣），1 例二尖瓣（生物瓣）。平均 Euroscore II 为 32.43（范围，9.19-50.8）。3 例患者有基础疾病（糖尿病=2，慢性阻塞性肺疾病=3，慢性肾脏病=1，外周动脉疾病=2，缺血性心脏病=1，扩张型心肌病=1）。术前临床表现为 3 例患者发生败血症，1 例患者发生心力衰竭和败血症。2 例患者有赘生物（二尖瓣生物瓣，主动脉生物瓣）。所有患者均存在人工瓣膜裂开，2 例患者存在局部环形脓肿。除 1 例患者外，其余患者均接受万古霉素联合利福平联合庆大霉素三联抗生素治疗。所有患者均紧急进行手术，院内死亡率为 50%。
虽然患者数量有限，但我们的系列研究强调了头葡萄球菌 PVE 的侵袭性临床病程，其死亡率接近金黄色葡萄球菌 PVE。因此，建议早期进行手术治疗，以改善这种严重疾病的临床预后。
