无结构性心脏病的感染性心内膜炎患者的特征。

Characteristics of patients with infective endocarditis and no underlying cardiac conditions.

机构信息

Université de Lorraine, CHRU-Nancy, Infectious and Tropical Diseases, Nancy, France.

Cardiology Department, CHU Nancy-Brabois, Nancy, France.

出版信息

Infect Dis (Lond). 2022 Sep;54(9):656-665. doi: 10.1080/23744235.2022.2078404. Epub 2022 May 23.

DOI:10.1080/23744235.2022.2078404

PMID:35604065

Abstract

BACKGROUND

Infective endocarditis (IE) typically occurs in patients with underlying cardiac conditions (UCC). Little is known about IE in patients without UCC. We aimed to describe the clinical, microbiological and imaging characteristics, management, and in-hospital mortality of IE patients without UCC.

METHODS

We analysed the data of patients with definite IE included in an observatory between 1st January 2009 and 31st December 2019. We described patients without UCC compared to those with UCC.

RESULTS

Of 1502 IE patients, 475 (31.6%) had no UCC. They were younger (median 64.0 [19.0-101.0] vs. 70.0 [18.0-104.0] years, < .001), more often on chronic haemodialysis (5.5% vs. 2.7%, = .008), and had more often malignancy (22.5% vs. 17.3%, = .017), immune deficiency (10.3% vs. 6.4%, = .008), and an indwelling central venous line (14.5% vs. 7.0%, < .001). They more often developed cerebral complications (34.7% vs. 27.5%, = .004) and extracerebral embolism (48.6% vs. 36.1%, < .001). Causative microorganisms were less often coagulase negative staphylococci (5.9% vs. 10.8%, = .002) or enterococci (10.3% vs. 15.0%, = .014) and more often group D streptococci (14.1% vs. 10.0%, = .020). Vegetations were more common (92.8% vs. 77.0%, < .001) and larger (14.0 [1.0-87.0], vs. 12.0 [0.5-60.0] mm, = .002). They had more valve perforation or valve regurgitation (67.4% vs. 53.0%, < .001) and underwent valve surgery more often (53.5% vs. 36.3%, < .001). In-hospital mortality did not significantly differ between groups.

CONCLUSION

Patients with IE and no UCC were younger than those with UCC, had specific comorbidities and portals of entry, and a more severe disease course.

摘要

背景

感染性心内膜炎（IE）通常发生于患有基础心脏疾病（UCC）的患者中。关于无 UCC 的 IE 患者，我们知之甚少。我们旨在描述无 UCC 的 IE 患者的临床、微生物学和影像学特征、治疗方法以及住院死亡率。

方法

我们分析了 2009 年 1 月 1 日至 2019 年 12 月 31 日期间在观察站中确诊的 IE 患者的数据。我们将无 UCC 的患者与有 UCC 的患者进行了比较。

结果

在 1502 例 IE 患者中，475 例（31.6%）无 UCC。与有 UCC 的患者相比，他们更年轻（中位数 64.0 [19.0-101.0] 岁 vs. 70.0 [18.0-104.0] 岁，<0.001），更多患有慢性血液透析（5.5% vs. 2.7%，=0.008），更常患有恶性肿瘤（22.5% vs. 17.3%，=0.017）、免疫缺陷（10.3% vs. 6.4%，=0.008）和留置中央静脉导管（14.5% vs. 7.0%，<0.001）。他们更常发生脑部并发症（34.7% vs. 27.5%，=0.004）和脑外栓塞（48.6% vs. 36.1%，<0.001）。致病微生物中凝固酶阴性葡萄球菌（5.9% vs. 10.8%，=0.002）或肠球菌（10.3% vs. 15.0%，=0.014）较少，而 D 组链球菌较多（14.1% vs. 10.0%，=0.020）。赘生物更常见（92.8% vs. 77.0%，<0.001）且更大（14.0 [1.0-87.0] 毫米 vs. 12.0 [0.5-60.0] 毫米，=0.002）。他们更常发生瓣叶穿孔或瓣叶反流（67.4% vs. 53.0%，<0.001），更常进行瓣膜手术（53.5% vs. 36.3%，<0.001）。两组患者的住院死亡率无显著差异。