Pitsikakis Konstantinos, Skandalakis Michail, Fragkiadakis Konstantinos, Baliou Stella, Ioannou Petros
School of Medicine, University of Crete, 71003 Heraklion, Greece.
MD, MSc, School of Medicine, University of Crete, 71003 Heraklion, Greece.
Germs. 2024 Jun 30;14(2):149-161. doi: 10.18683/germs.2024.1427. eCollection 2024 Jun.
Infective endocarditis (IE) is a disease that may frequently lead to significant morbidity and is associated with high mortality rates. Even though IE is classically caused by Gram-positive bacteria, Gram-negative bacteria may seldom cause IE. Antimicrobial resistance (AMR) may pose significant problems in treating IE, especially for carbapenem-resistant pathogens. This study aimed to review all cases of IE by carbapenem-resistant Gram-negative bacteria in a systematic way and present information on epidemiology, clinical findings, treatment, and outcomes.
A systematic review of PubMed, Cochrane Library, and Scopus (all published studies up to 6 August 2023) for published studies providing information on epidemiology, clinical findings, treatment, and outcomes of IE by carbapenem-resistant Gram-negative bacteria was performed.
A total of 24 studies containing data from 26 patients were included. Among all patients, 53.9% were male, and the median age was 66 years. Among all patients, 38.5% had a history of a prosthetic valve. The most commonly affected valve was the aortic, followed by the mitral valve. Fever, sepsis, emboli, and shock were the most frequent clinical findings. The most commonly isolated pathogens were and . Aminoglycosides, colistin, cephalosporins, and carbapenems were the most commonly used antimicrobials. Surgery was performed in 53.8% of patients. Mortality was 38.5%.
The development of infection control measures and antimicrobial stewardship interventions is needed to reduce the spread of AMR and the likelihood of this fatal infection.
感染性心内膜炎（IE）是一种常导致严重发病且死亡率高的疾病。尽管IE通常由革兰氏阳性菌引起，但革兰氏阴性菌很少引发IE。抗菌药物耐药性（AMR）在治疗IE时可能带来重大问题，尤其是对于耐碳青霉烯类病原体。本研究旨在系统回顾所有耐碳青霉烯类革兰氏阴性菌引起的IE病例，并呈现有关流行病学、临床发现、治疗及预后的信息。
对PubMed、Cochrane图书馆和Scopus（截至2023年8月6日的所有已发表研究）进行系统综述，以获取有关耐碳青霉烯类革兰氏阴性菌引起的IE的流行病学、临床发现、治疗及预后的已发表研究信息。
共纳入24项包含26例患者数据的研究。所有患者中，53.9%为男性，中位年龄为66岁。所有患者中，38.5%有人工瓣膜病史。最常受累的瓣膜是主动脉瓣，其次是二尖瓣。发热、败血症、栓塞和休克是最常见的临床发现。最常分离出的病原体是[此处原文缺失具体病原体名称]和[此处原文缺失具体病原体名称]。氨基糖苷类、黏菌素、头孢菌素和碳青霉烯类是最常用的抗菌药物。53.8%的患者接受了手术。死亡率为38.5%。
需要制定感染控制措施和抗菌药物管理干预措施，以减少AMR的传播及这种致命感染发生的可能性。
