埃塞俄比亚提格雷阿德尔综合专科医院感染性心内膜炎相关住院死亡率的预测因素：微生物学、临床特征和管理特征。
Predictors of infective endocarditis associated in-hospital mortality in Ayder Comprehensive Specialized Hospital, Tigray, North Ethiopia: Microbiological,clinical features, and management profiles.
机构信息
Department of Internal Medicine, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Tigray Region, Ethiopia.
Department of Medical Microbiology and Immunology, College of Health Sciences, Mekelle University, Mekelle, Tigray Region, Ethiopia.
出版信息
PLoS One. 2024 May 2;19(5):e0300322. doi: 10.1371/journal.pone.0300322. eCollection 2024.
BACKGROUND
Infective endocarditis (IE) is a continuously evolving disease with a high mortality rate despite different advances in treatment. In Ethiopia, there is a paucity of data regarding IE. Therefore, this study is aimed at assessing IE-related in-hospital mortality and characterization of IE patients based on their microbiological, clinical features, and management profiles in the Ayder Comprehensive Specified Hospital (ACSH).
METHODS
We conducted a hospital-based prospective follow-up study with all consecutive sampling techniques for suspected infective endocarditis patients admitted to ACSH from January 2020 to February 2022. Echocardiography was performed, and three sets of blood samples for blood culture were taken as per the standard protocol. We also performed isolation of microbial etiologies and antimicrobial susceptibility tests. The data was analyzed using STATA version 16. Stepwise logistic regression was run to identify predictors of in-hospital mortality. Effects were measured through the odds ratio at the 5% level of significance.
RESULTS
Seventy-four cases of suspected infective endocarditis were investigated; of these, 54 episodes fulfilled modified Duke's criteria. Rheumatic heart disease (RHD) (85.2%) was the most common underlying heart disease. Murmur (94.4%), fever (68.5%), and pallor (57.4%) were the most common clinical findings. Vegetation was present in 96.3% of episodes. Blood culture was positive only in 7 (13%) episodes. Complications occurred in 41 (75.9%) cases, with congestive heart failure being the most common. All patients were managed medically, with no surgical intervention. The in-hospital mortality was 14 (25.9%). IE-related in-hospital mortality was significantly associated with surgery recommendation and myalgia clinical symptoms.
CONCLUSION
IE occurred relatively in a younger population, with RHD as the most common underlying heart disease. There was a high rate of culture-negative endocarditis, and the majority of patients were treated empirically. Mortality was high. The establishment of cardiac surgery and strengthening microbiology services should be given top priority.
背景
感染性心内膜炎（IE）是一种不断演变的疾病，尽管在治疗方面取得了不同的进展，但死亡率仍然很高。在埃塞俄比亚，关于 IE 的数据很少。因此，本研究旨在评估 Ayder 综合专科医院（ACSH）IE 相关的住院死亡率，并根据微生物学、临床特征和管理特征对 IE 患者进行特征描述。
方法
我们采用医院前瞻性随访研究，对 2020 年 1 月至 2022 年 2 月期间入住 ACSH 的疑似感染性心内膜炎患者进行连续采样。按照标准方案进行超声心动图检查，并采集三套血样进行血培养。我们还进行了微生物病因的分离和药敏试验。使用 STATA 版本 16 进行数据分析。逐步逻辑回归用于确定住院死亡率的预测因素。在 5%的显著性水平下，通过比值比来衡量效果。
结果
共调查了 74 例疑似感染性心内膜炎患者，其中 54 例符合改良的 Duke 标准。风湿性心脏病（RHD）（85.2%）是最常见的潜在心脏病。杂音（94.4%）、发热（68.5%）和苍白（57.4%）是最常见的临床发现。96.3%的病例有赘生物。仅 7 例（13%）血培养阳性。41 例（75.9%）发生并发症，其中充血性心力衰竭最常见。所有患者均接受药物治疗，无手术干预。住院死亡率为 14 例（25.9%）。IE 相关住院死亡率与手术推荐和肌痛临床症状显著相关。
结论
IE 相对发生在较年轻的人群中，RHD 是最常见的潜在心脏病。血培养阴性的心内膜炎发生率较高，大多数患者接受经验性治疗。死亡率很高。应优先建立心脏手术和加强微生物学服务。
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