Braimbridge M V, Eykyn S J
Department of Cardiothoracic Surgery, St Thomas' Hospital, London, UK.
J Antimicrob Chemother. 1987 Sep;20 Suppl A:173-80. doi: 10.1093/jac/20.suppl_a.173.
About 2% of patients with a prosthetic valve will develop endocarditis. This may occur within a few weeks of the valve replacement operation (early) or many months or years later (late). The infecting organisms, pathogenicity and prognosis differ in the two groups. The incidence of early prosthetic valve endocarditis (PVE) is under 1%; the predominant organisms are staphylococci that are acquired in the operating theatre or in the intensive therapy unit. Early PVE usually follows wound sepsis that may initially appear trivial. The mortality rate is around 70%, but such infections should be preventable by stringent antisepsis, good surgical technique and (perhaps) perioperative antistaphylococcal antibiotics. The incidence of late PVE is about 1% per annum. The infecting organisms are similar to those causing native valve endocarditis, predominantly streptococci. The commonest source of these organisms is the mouth and regular dental care and appropriate prophylactic antibiotics should help to prevent infection. The mortality rate of late PVE is around 10%. Failure of medical treatment in PVE is an indication for surgery to remove the infected valve(s) and this should not be delayed. The optimum length of treatment for PVE is unknown but it is seldom necessary to give antibiotics for more than 6 weeks except in Coxiella burnetii infection.
人工瓣膜置换术后约2%的患者会发生心内膜炎。这可能在瓣膜置换手术后几周内（早期）发生，也可能在数月或数年之后（晚期）发生。两组患者的感染病原体、致病性及预后有所不同。早期人工瓣膜心内膜炎（PVE）的发生率低于1%；主要病原体是在手术室或重症监护病房感染的葡萄球菌。早期PVE通常继发于起初看似轻微的伤口脓毒症。死亡率约为70%，但通过严格的防腐措施、良好的手术技术以及（或许）围手术期使用抗葡萄球菌抗生素，此类感染应可预防。晚期PVE的发生率约为每年1%。感染病原体与引起自身瓣膜心内膜炎的病原体相似，主要是链球菌。这些病原体最常见的来源是口腔，定期的牙齿护理及适当的预防性抗生素有助于预防感染。晚期PVE的死亡率约为10%。PVE内科治疗无效是手术切除感染瓣膜的指征，不应延误。PVE的最佳治疗时长尚不清楚，但除了伯氏考克斯体感染外，很少需要使用抗生素超过6周。
