Wilson W R, Wilkowske C J, Wright A J, Sande M A, Geraci J E
Ann Intern Med. 1984 Jun;100(6):816-23. doi: 10.7326/0003-4819-100-6-816.
Fifty-six patients with enterococcal endocarditis received 4 weeks of antimicrobial therapy with penicillin G and streptomycin (36 patients) or, if infections were streptomycin resistant, penicillin and gentamicin (20 patients). Compared with patients who had symptoms for less than 3 months, patients with symptoms for more than 3 months had a higher relapse rate (0% versus 44%; p less than 0.001) and mortality (2.5% versus 25%; p less than 0.001). Patients with mitral valve endocarditis had a significantly higher relapse rate (25%) than patients with aortic valve infections (0%) (p less than 0.01). Gentamicin-associated nephrotoxicity was more frequent (p less than 0.001) among patients treated with greater than 3 mg/kg d of gentamicin than among those treated with 3 mg or less (100% versus 20%). Relapse and mortality rates did not differ significantly between patients treated with low-dose or high-dose gentamicin regimens. Patients who have had symptoms of enterococcal endocarditis for more than 3 months or patients with mitral valve infection should receive at least 6 weeks of antimicrobial therapy, but patients without these high-risk factors can be treated for 4 weeks.
56例肠球菌性心内膜炎患者接受了4周的抗菌治疗，其中36例使用青霉素G和链霉素，另外20例若感染对链霉素耐药，则使用青霉素和庆大霉素。与症状持续时间少于3个月的患者相比，症状持续时间超过3个月的患者复发率更高（0%对44%；P<0.001），死亡率也更高（2.5%对25%；P<0.001）。二尖瓣心内膜炎患者的复发率（25%）显著高于主动脉瓣感染患者（0%）（P<0.01）。庆大霉素剂量大于3mg/kg·d的患者中庆大霉素相关肾毒性比剂量为3mg或更低的患者更常见（P<0.001）（100%对20%）。低剂量或高剂量庆大霉素治疗方案的患者复发率和死亡率无显著差异。有肠球菌性心内膜炎症状超过3个月的患者或二尖瓣感染患者应接受至少6周的抗菌治疗，但无这些高危因素的患者可治疗4周。
