Cooper R, Mills J
Arch Intern Med. 1980 Feb;140(2):199-202.
Seventeen new cases of Serratia marcescens endocarditis observed in the San Francisco Bay Area since June 1974 are presented. Fifteen patients had a history of illicit intravenous drug use and four patients had prosthetic heart valves. Seven patients with infection of right-sided heart valves did well, although surgery was required in two for persistent fever or recurrent pulmonary emboli. Only three of ten patients with left-sided infection survived despite synergistic antibiotic combinations and high serum bactericidal titers. Fifteen isolates of Serratia from patients with endocarditis were serotyped, and none of these serotypes corresponded to the pigmented strain aerosolized by the US Army in the Bay Area in 1951. The isolation of the same Serratia strain from two patients and their shared injection paraphernalia provided insight into the pathogenesis of endocarditis in the intravenous drug user. A revised therapeutic approach to this difficult infection is presented.
本文介绍了自1974年6月以来在旧金山湾区观察到的17例粘质沙雷氏菌心内膜炎新病例。15例患者有非法静脉注射毒品史，4例患者有人工心脏瓣膜。7例右侧心脏瓣膜感染患者情况良好，尽管其中2例因持续发热或反复肺栓塞需要手术治疗。尽管使用了联合抗生素且血清杀菌效价较高，但10例左侧感染患者中只有3例存活。对15株来自心内膜炎患者的粘质沙雷氏菌进行了血清分型，这些血清型均与1951年美国陆军在湾区雾化的色素沉着菌株不符。从两名患者身上分离出相同的粘质沙雷氏菌菌株以及他们共用的注射用具，为了解静脉吸毒者心内膜炎的发病机制提供了线索。本文还提出了针对这种难治性感染的修订治疗方法。
