印度静脉药物滥用者感染性心内膜炎的临床特征和结局。
Clinical characteristics and outcome of infective endocarditis among intravenous drug abusers in India.
机构信息
Department of Cardiology, Dayanand Medical College and Hospital, Unit Hero DMC Heart Institute, Ludhiana, India.
Department of Cardiology, Dayanand Medical College and Hospital, Unit Hero DMC Heart Institute, Ludhiana, India.
出版信息
Indian Heart J. 2020 Nov-Dec;72(6):547-551. doi: 10.1016/j.ihj.2020.09.014. Epub 2020 Sep 18.
INTRODUCTION
Infective endocarditis (IE) is the most dreaded complication of intravenous drug abuse (IVDA). IVDA is present in significant proportions in India. Since there is scarcity of Indian data on IVDA associated IE, we report a study comparing IVDA to non IVDA associated IE. We compare differences in clinical profile, microbiology, echocardiography and clinical outcome from a tertiary care hospital.
METHODS
A total of 133 patients admitted from 1st January 2017 to 31st December 2019 who met the Modified Duke ''definitive'' criteria for IE were included. Detailed Information was collected regarding demography, clinical data and laboratory investigations. All patients underwent transthoracic echocardiography and trans-esophageal echocardiogram wherever necessary.
RESULTS
Among a total of 133 patients, 54 patients (40.6%) were iv drug abusers. Patients in IVDA-group were younger, mostly males, more likely to have concomitant HCV and HIV infections compared to non IVDA-group. Chronic comorbidities such as DM and CKD were more common in non IVDA-group. Rate of positive blood culture was higher in IVDA-group compared to non IVDA-group (74.1%v/s 32.9%,p < 0.001) with different microbiological profile. Percentage of Methicillin resistant staphylococcus aureus (42.6%v/s17.7%,p = 0.003) and pseudomonas related IE (18.5%v/s2.5%,p = 0.003) was significantly higher among IVDA-group. IVDA-group most commonly had tricuspid valve involvement Whereas mitral and aortic valve were most commonly involved valve in non IVDA-group. Mortality was slightly higher among IVDA-group compared to non IVDA-group, though statistically non-significant. Left sided valve involvement and Congestive heart failure were independent predictors of mortality.
CONCLUSION
IVDA-IE is a significant problem in India. Demographic, microbiological and echocardiographic profile is quite different in IVDA and non IVDA-group. There is urgent need to conduct larger studies.
引言
感染性心内膜炎（IE）是静脉药物滥用（IVDA）最可怕的并发症。IVDA 在印度的比例相当高。由于缺乏印度关于 IVDA 相关 IE 的数据，我们报告了一项比较 IVDA 与非 IVDA 相关 IE 的研究。我们比较了一家三级保健医院的临床特征、微生物学、超声心动图和临床结果的差异。
方法
2017 年 1 月 1 日至 2019 年 12 月 31 日期间，共有 133 名符合改良 Duke“明确”IE 标准的患者入选。详细收集了人口统计学、临床数据和实验室检查信息。所有患者均行经胸超声心动图和经食管超声心动图检查。
结果
在总共 133 名患者中，54 名（40.6%）是静脉药物滥用者。IVDA 组患者年龄较小，大多数为男性，与非 IVDA 组相比，更有可能同时感染 HCV 和 HIV。非 IVDA 组更常见慢性合并症，如糖尿病和慢性肾脏病。IVDA 组的血培养阳性率高于非 IVDA 组（74.1%比 32.9%，p<0.001），微生物学特征也不同。IVDA 组耐甲氧西林金黄色葡萄球菌（42.6%比 17.7%，p=0.003）和与假单胞菌相关的 IE（18.5%比 2.5%，p=0.003）的比例明显更高。IVDA 组最常见三尖瓣受累，而非 IVDA 组最常见二尖瓣和主动脉瓣受累。IVDA 组的死亡率略高于非 IVDA 组，但统计学上无显著性差异。左侧瓣膜受累和充血性心力衰竭是死亡的独立预测因素。
结论
IVDA-IE 在印度是一个严重的问题。IVDA 和非 IVDA 组在人口统计学、微生物学和超声心动图特征方面存在显著差异。迫切需要开展更大规模的研究。
Zotero 插件