南非西开普省感染性心内膜炎的病因：采用一套病原体检测方案和感染性心内膜炎专家组进行中心决策的前瞻性队列研究。
Causes of infective endocarditis in the Western Cape, South Africa: a prospective cohort study using a set protocol for organism detection and central decision making by an endocarditis team.
机构信息
Medicine, Division of Cardiology, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
Microbiology, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa.
出版信息
BMJ Open. 2021 Dec 6;11(12):e053169. doi: 10.1136/bmjopen-2021-053169.
BACKGROUND
Blood culture negative infective endocarditis (BCNIE) poses both a diagnostic and therapeutic challenge. High rates of BCNIE reported in South Africa have been attributed to antibiotic use prior to blood culture sampling.
OBJECTIVES
To assess the impact of a systematic approach to organism detection and identify the causes of infective endocarditis (IE), in particular causes of BCNIE.
DESIGN
Prospective cohort study.
METHODS
The Tygerberg Endocarditis Cohort study prospectively enrolled patients with IE between November 2019 and February 2021. A set protocol for organism detection with management of patients by an endocarditis team was employed. This prospective cohort was compared with a retrospective cohort of patients with IE admitted between January 2017 and December 2018.
RESULTS
One hundred and forty patients with IE were included, with 75 and 65 patients in the retrospective and prospective cohorts, respectively. Baseline demographic characteristics were similar with a mean age of 39.6 years and male predominance (male sex=67.1%). The rate of BCNIE was lower in the prospective group (28/65 or 43.1%) compared with the retrospective group (47/75 or 62.7%; p=0.039). The BCNIE in-hospital mortality rate in the retrospective cohort was 23.4% compared with 14.2% in the prospective cohort (p=0.35). A cause was identified (including non-culture techniques) in 86.2% of patients in the prospective cohort, with (26.2%), species (20%) and the viridans streptococci (15.3%) being most common.
CONCLUSION
The introduction of a set protocol for organism detection, managed by an endocarditis team, has identified as the most common cause of IE and identified non-culturable organisms, in particular , as an important cause of BCNIE. A reduction in in-hospital mortality in patients with BCNIE was observed, but did not reach statistical significance.
背景
血培养阴性感染性心内膜炎（BCNIE）既具有诊断挑战性，又具有治疗挑战性。南非报道的 BCNIE 发生率较高，这归因于血培养采样前使用抗生素。
目的
评估采用系统方法检测病原体并确定感染性心内膜炎（IE）病因，特别是 BCNIE 病因的影响。
设计
前瞻性队列研究。
方法
Tygerberg 心内膜炎队列研究前瞻性纳入 2019 年 11 月至 2021 年 2 月期间患有 IE 的患者。采用一套病原体检测方案，并由心内膜炎团队管理患者。该前瞻性队列与 2017 年 1 月至 2018 年 12 月期间收治的 IE 患者回顾性队列进行比较。
结果
共纳入 140 例 IE 患者，其中回顾性队列 75 例，前瞻性队列 65 例。两组基线人口统计学特征相似，平均年龄为 39.6 岁，男性居多（男性 67.1%）。与回顾性队列（47/75 或 62.7%；p=0.039）相比，前瞻性队列的 BCNIE 发生率较低（28/65 或 43.1%）。回顾性队列的 BCNIE 住院死亡率为 23.4%，而前瞻性队列为 14.2%（p=0.35）。前瞻性队列中 86.2%的患者确定了病因（包括非培养技术），最常见的病因包括（26.2%）、（20%）和草绿色链球菌（15.3%）。
结论
采用一套由心内膜炎团队管理的病原体检测方案，确定了为 IE 最常见的病因，并确定了非可培养病原体，特别是作为 BCNIE 的重要病因。BCNIE 患者的住院死亡率有所降低，但未达到统计学意义。
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