Rodríguez Esteban M, Ode Febles J, Miranda Montero S I, Ramos López M, Farrais Villalba M, Álvarez Acosta L, Quijada Fumero A, Hernández Afonso J, Cabrera León A
Marcos Rodríguez Esteban. Servicio de Cardiología. Hospital Universitario Nuestra Señora de Candelaria. Ctra del Rosario, 135. 38010. Santa Cruz de Tenerife. Spain.
Rev Esp Quimioter. 2021 Apr;34(2):100-106. doi: 10.37201/req/103.2020. Epub 2021 Jan 25.
One of the most aggressive microorganisms in infective endocarditis (IE) is Staphylococcus aureus. We analyse the resistance of S. aureus to antibiotics and its impact on the clinical course of IE in a recent 15-year period.
Retrospective study of patients with IE in a university hospital from 2005 to 2019. Bivariate and multivariate analysis of severity at admission, comorbidities, minimum inhibitory concentrations (MIC) and mortality.
Of the 293 IE cases, 66 (22.5%) were due to S. aureus, and 21 (7.2%) were methicillin-resistant S. aureus (MRSA). The prevalence of strains with a MIC to vancomycin ≥ 1mg/L increased from 4.8% to 63.6% (p <0.001) and the cases of MRSA from 38 to 27.3% (p = 0.045). Older age (p= 0.02), comorbidity (p <0.01) and nosohusial origin (p = 0.01), were factors associated with MRSA. But the antimicrobial resistance and severity on admission were not associated with exitus; predictive factors were the right-sided IE (OR = 0.08; 95% CI: 0.01-0.51), comorbidities (OR per Charlson index point = 1.30; 95% CI: 1.01-1.69) and creatinine on admission (OR per mg / dL = 1.56; 95% CI = 1.01- 2.35; p = 0.04).
We have experienced an increase in IE cases with MIC to vancomycin ≥ 1mg/L, without significant variation in infections due to MRSA. Antimicrobial resistance was not associated with mortality, but comorbidity and left involvement were predictive factors.
金黄色葡萄球菌是感染性心内膜炎（IE）中最具侵袭性的微生物之一。我们分析了最近15年期间金黄色葡萄球菌对抗生素的耐药性及其对IE临床病程的影响。
对2005年至2019年某大学医院的IE患者进行回顾性研究。对入院时的严重程度、合并症、最低抑菌浓度（MIC）和死亡率进行双变量和多变量分析。
在293例IE病例中，66例（22.5%）由金黄色葡萄球菌引起，21例（7.2%）为耐甲氧西林金黄色葡萄球菌（MRSA）。对万古霉素MIC≥1mg/L的菌株患病率从4.8%增至63.6%（p<0.001），MRSA病例从38例增至27.3%（p=0.045）。年龄较大（p=0.02）、合并症（p<0.01）和医院感染源（p=0.01）是与MRSA相关的因素。但入院时的抗菌药物耐药性和严重程度与死亡无关；预测因素为右侧IE（OR=0.08；95%CI：0.01-0.51）、合并症（每Charlson指数点的OR=1.30；95%CI：1.01-1.69）和入院时的肌酐水平（每mg/dL的OR=1.56；95%CI=1.01-2.35；p=0.04）。
我们发现对万古霉素MIC≥1mg/L的IE病例有所增加，而MRSA引起的感染无显著变化。抗菌药物耐药性与死亡率无关，但合并症和左侧受累是预测因素。
