Terpenning M S, Buggy B P, Kauffman C A
Department of Internal Medicine, University of Michigan Medical School, Ann Arbor.
Am J Med. 1987 Oct;83(4):626-34. doi: 10.1016/0002-9343(87)90890-4.
The elderly constitute an increasing percentage of patients with infective endocarditis. The disease manifestations and outcomes in 53 episodes of endocarditis in patients over the age of 60 were reviewed and compared with 55 episodes of endocarditis in patients less than 40 years of age and 46 episodes of endocarditis in patients aged 40 to 60. The percentage of cases caused by staphylococci and streptococci were roughly equal in all groups. Enterococci, Streptococcus bovis, and coagulase-negative staphylococci were more common in the elderly. In the elderly, invasive vascular procedures were the most common source of infection. Endocarditis acquired nosocomially accounted for 23 percent of all episodes in older patients. The elderly reported fewer symptoms and showed a diminished febrile response. Errors in diagnosis were noted in 68 percent of elderly patients, and a delay in initiating appropriate therapy was more common in this age group. The mortality rate was significantly higher in the elderly (45.3 percent) than in the middle-aged (32.6 percent) and young (9.1 percent). Endocarditis in elderly patients is often nosocomially acquired, is difficult to diagnose, and is associated with a higher mortality than noted in younger patients.
老年人在感染性心内膜炎患者中所占比例日益增加。对60岁以上患者的53例心内膜炎发作的疾病表现和结局进行了回顾，并与40岁以下患者的55例心内膜炎发作以及40至60岁患者的46例心内膜炎发作进行了比较。所有组中由葡萄球菌和链球菌引起的病例百分比大致相等。肠球菌、牛链球菌和凝固酶阴性葡萄球菌在老年人中更为常见。在老年人中，侵入性血管操作是最常见的感染源。医院获得性心内膜炎占老年患者所有发作的23%。老年人报告的症状较少，发热反应减弱。68%的老年患者存在诊断错误，该年龄组更常见开始适当治疗的延迟。老年人的死亡率（45.3%）显著高于中年（32.6%）和青年（9.1%）患者。老年患者的心内膜炎通常是医院获得性的，难以诊断，且与比年轻患者更高的死亡率相关。
