Kaushik Ashlesha, Kest Helen, Sood Mangla, Thieman Corey, Steussy Bryan W, Padomek Michael, Gupta Sandeep
Division of Pediatric Infectious Diseases, Unity Point Health at St. Luke's Regional Medical Center and University of Iowa Carver College of Medicine, 2720 Stone Park Blvd, Sioux City, IA 51104, USA.
Division of Pediatric Infectious Diseases, St. Joseph's Children's Hospital, 703 Main Street, Paterson, NJ 07503, USA.
Antibiotics (Basel). 2024 Nov 25;13(12):1132. doi: 10.3390/antibiotics13121132.
Infective endocarditis (IE) is a life-threatening condition with increasing global incidence, primarily caused by , especially methicillin-resistant strains (MRSA). Biofilm formation by is a critical factor in pathogenesis, contributing to antimicrobial resistance and complicating the treatment of infections involving prosthetic valves and cardiovascular devices. Biofilms provide a protective matrix for MRSA, shielding it from antibiotics and host immune defenses, leading to persistent infections and increased complications, particularly in cases involving prosthetic materials. Clinical manifestations range from acute to chronic presentations, with complications such as heart failure, embolic events, and neurological deficits. Diagnosis relies on the Modified Duke Criteria, which have been updated to incorporate modern cardiovascular interventions and advanced imaging techniques, such as PET/CT (positron emission tomography, computed tomography), to improve the detection of biofilm-associated infections. Management of MRSA-associated IE requires prolonged antimicrobial therapy, often with vancomycin or daptomycin, needing a combination of antimicrobials in the setting of prosthetic materials and frequently necessitates surgical intervention to remove infected prosthetic material or repair damaged heart valves. Anticoagulation remains controversial, with novel therapies like dabigatran showing potential benefits in reducing thrombus formation. Despite progress in treatment, biofilm-associated resistance poses ongoing challenges. Emerging therapeutic strategies, including combination antimicrobial regimens, bacteriophage therapy, antimicrobial peptides (AMPs), quorum sensing inhibitors (QSIs), hyperbaric oxygen therapy, and nanoparticle-based drug delivery systems, offer promising approaches to overcoming biofilm-related resistance and improving patient outcomes. This review provides an overview of the pathogenesis, current management guidelines, and future directions for treating biofilm-related MRSA IE.
感染性心内膜炎（IE）是一种危及生命的疾病，全球发病率呈上升趋势，主要由[病原体名称未给出]引起，尤其是耐甲氧西林菌株（MRSA）。[病原体名称未给出]形成生物膜是发病机制中的一个关键因素，导致抗菌药物耐药性，并使涉及人工瓣膜和心血管装置的感染治疗复杂化。生物膜为MRSA提供了一个保护性基质，使其免受抗生素和宿主免疫防御的影响，导致持续性感染并增加并发症，特别是在涉及人工材料的病例中。临床表现从急性到慢性不等，伴有心力衰竭、栓塞事件和神经功能缺损等并发症。诊断依赖于改良的杜克标准，该标准已更新，纳入了现代心血管干预措施和先进的成像技术，如PET/CT（正电子发射断层扫描、计算机断层扫描），以提高对生物膜相关感染的检测。MRSA相关IE的管理需要延长抗菌治疗时间，通常使用万古霉素或达托霉素，在存在人工材料的情况下需要联合使用抗菌药物，并且经常需要手术干预以去除感染的人工材料或修复受损的心脏瓣膜。抗凝治疗仍存在争议，达比加群等新型疗法在减少血栓形成方面显示出潜在益处。尽管在治疗方面取得了进展，但生物膜相关的耐药性仍然带来持续挑战。新兴的治疗策略，包括联合抗菌方案、噬菌体疗法、抗菌肽（AMPs）、群体感应抑制剂（QSIs）、高压氧疗法和基于纳米颗粒的药物递送系统，为克服生物膜相关耐药性和改善患者预后提供了有前景的方法。本综述概述了生物膜相关MRSA IE的发病机制、当前管理指南和未来治疗方向。
