Lawson Eli, Jacques Angela, Italiano Claire, Robinson James O
Department of Infectious Diseases, Royal Perth Hospital, Perth, Western Australia, Australia.
Institute for Health Research, University of Notre Dame Australia, Perth, Western Australia, Australia.
Intern Med J. 2024 Dec;54(12):2027-2036. doi: 10.1111/imj.16508. Epub 2024 Aug 28.
Infective endocarditis (IE) is a severe infection with considerable mortality. It is associated with geographical variation, complicating diagnosis and treatment of patients in a standardised manner.
To evaluate the characteristics and management outcomes of patients with IE in Royal Perth Hospital (RPH).
A single-centre, retrospective cohort study. Data were collected from medical records of 131 patients with a diagnosis of IE admitted to RPH between 2016 and 2021.
Eighty-four patients with definite IE were included for analysis. The median age of patients was 51.5 years and 77.4% were male. Compared to the general Australian population, there was disproportionately greater representation of Indigenous Australians (21.4%), those with a history of injecting drug use (IDU) (27.4%), rheumatic heart disease (14.3%) and previous IE (13.1%). The most commonly affected valve was the mitral valve in 46.4% of patients, and the most common pathogen was Staphylococcus aureus in 47.6% of patients. Twelve-month mortality was 16.7%, with significantly increased mortality in those treated non-surgically (25.6% vs 7.3%, P = 0.025). Factors associated with undergoing surgery included the presence of aortic valve disease, perivalvular extension of infection and infection with Enterococcus faecalis, whereas IDU, tricuspid valve disease and S. aureus infection were associated with non-surgical management. Adherence to multidisciplinary team review was 75.0%, and surgical management was performed in 70.7% of patients meeting an indication for surgery.
IE mortality rates remain high, particularly in patients who do not undergo surgical management. Streamlined MDT assessment and referral for surgical management where appropriate is necessary to improve outcomes.
感染性心内膜炎（IE）是一种严重感染，死亡率颇高。它存在地域差异，这使得以标准化方式对患者进行诊断和治疗变得复杂。
评估皇家珀斯医院（RPH）中IE患者的特征及治疗结果。
一项单中心回顾性队列研究。收集了2016年至2021年间入住RPH的131例诊断为IE患者的病历资料。
84例确诊IE患者纳入分析。患者中位年龄为51.5岁，77.4%为男性。与澳大利亚普通人群相比，澳大利亚原住民（21.4%）、有注射吸毒史（IDU）者（27.4%）、风湿性心脏病患者（14.3%）及既往有IE病史者（13.1%）的比例过高。最常受累瓣膜为二尖瓣，占46.4%的患者；最常见病原体为金黄色葡萄球菌，占47.6%的患者。12个月死亡率为16.7%，非手术治疗患者死亡率显著升高（25.6%对7.3%，P = 0.025）。与接受手术相关的因素包括存在主动脉瓣疾病、感染的瓣周扩展及粪肠球菌感染，而IDU、三尖瓣疾病及金黄色葡萄球菌感染与非手术治疗相关。多学科团队评估的依从率为75.0%，70.7%符合手术指征的患者接受了手术治疗。
IE死亡率仍然很高，尤其是在未接受手术治疗的患者中。简化多学科团队评估并在适当情况下转诊进行手术治疗对于改善治疗结果很有必要。
