保加利亚感染性心内膜炎的趋势：特征与结局，17年单中心经验
Trend in Infective Endocarditis in Bulgaria: Characteristics and Outcome, 17-Years, Single Center Experience.
作者信息
Dobreva-Yatseva Bistra, Nikolov Fedya, Raycheva Ralitsa, Uchikov Petar, Tokmakova Mariya
机构信息
Section of Cardiology Cardiology Clinic, First Department of Internal Medicine, Faculty of Medicine, Medical University-Plovdiv, UMBAL "St. Georgi" EAD, 4000 Plovdiv, Bulgaria.
Department of Social Medicine and Public Health, Faculty of Public Health, Medical University-Plovdiv, 4000 Plovdiv, Bulgaria.
出版信息
Microorganisms. 2024 Aug 9;12(8):1631. doi: 10.3390/microorganisms12081631.
BACKGROUND
Infective endocarditis (IE) remains a difficult disease to diagnose and treat, with a persistently high mortality rate. There is a lack of recent data on IE in Bulgaria over the last decades.
METHODS
This study is retrospective, single-centered, and includes 270 patients diagnosed with IE for the period 2005-2021. We compared two periods, 2005-2015 (n = 119) and 2016-2021 (n = 151), to find the characteristics changes.
RESULTS
The study included 177 (65.5%) male patients. In the second period, there is a significant increase in age from 62 (44-73) to 67 (53-75), ( = 0.023); in the Charlson comorbidities index (CCI) from 3 (1-4) to 4 (2-6), ( = 0.000); in cases with chronic kidney diseases (CKDs) from 15 (12.6%) to 55 (36.9%), ( = 0.001); coronary arterial diseases (CADs) from 20 (16.85%) to 44 (29.1%), ( = 0.018); and atrial fibrillation (AF) from 13 (10.9%) to 36 (23.8%), ( = 0.006). Ejection fraction decreased significantly in the second period from 63 (56-70) to 59 (51-66), ( = 0.000). Almost half of the patients 123 (45.6%) had no known predisposing cardiac condition, and 125 (46.3%) had an unknown port of entry. IE was community-acquired in 174 (64.4%), healthcare-associated in 72 (26.7%), and injection-drug-use-related IE in 24 (8.9%). The study population included 183 (67.8%) native valve IE, 85 (31.5%) prosthetic IE, and 2 (0.74%) intracardiac-device-related IE. The hemocultures were positive in 159 (59.6%), and the most frequent pathogenic agent was staphylococci-89 (33.3%) (-44 (16.5%) and coagulase negative staphylococci-45 (16.8%)). Only 54 (20%) of patients underwent early surgery. The all-cause 30-day mortality rate was 67 (24.8%). There is no significant difference between the two periods in terms of the characteristics listed above.
CONCLUSIONS
The profile of IE in Bulgaria has changed with increasing age and comorbidity, changing predisposing cardiac conditions, and entry door. The most common pathogen was the spp. The 30-day mortality rate remains high.
背景
感染性心内膜炎（IE）仍然是一种难以诊断和治疗的疾病，死亡率一直居高不下。过去几十年保加利亚缺乏关于IE的最新数据。
方法
本研究为回顾性、单中心研究，纳入了2005年至2021年期间诊断为IE的270例患者。我们比较了两个时期，2005 - 2015年（n = 119）和2016 - 2021年（n = 151），以发现特征变化。
结果
该研究纳入了177例（65.5%）男性患者。在第二个时期，年龄从62岁（44 - 73岁）显著增加到67岁（53 - 75岁），（P = 0.023）；Charlson合并症指数（CCI）从3（1 - 4）增加到4（2 - 6），（P = 0.000）；慢性肾脏病（CKD）患者从15例（12.6%）增加到55例（36.9%），（P = 0.001）；冠状动脉疾病（CAD）患者从20例（16.85%）增加到44例（29.1%），（P = 0.018）；心房颤动（AF）患者从13例（10.9%）增加到36例（23.8%），（P = 0.006）。第二个时期射血分数从63（56 - 70）显著下降到59（51 - 66），（P = 0.000）。几乎一半的患者123例（45.6%）没有已知的易患心脏疾病，125例（46.3%）的感染入口不明。IE为社区获得性的有174例（64.4%），医疗保健相关的有72例（26.7%），与注射吸毒相关的IE有24例（8.9%）。研究人群包括183例（67.8%）天然瓣膜IE，85例（31.5%）人工瓣膜IE，以及2例（0.74%）心内装置相关IE。血培养阳性的有159例（59.6%），最常见的病原体是葡萄球菌 - 89例（33.3%）（其中金黄色葡萄球菌 - 44例（16.5%）和凝固酶阴性葡萄球菌 - 45例（16.8%））。只有54例（20%）患者接受了早期手术。全因30天死亡率为67例（24.8%）。上述特征在两个时期之间没有显著差异。
结论
保加利亚IE的特征随着年龄增长、合并症增加、易患心脏疾病变化以及感染入口的改变而发生了变化。最常见的病原体是葡萄球菌属。30天死亡率仍然很高。
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