Geraci J E, Wilson W R
Mayo Clin Proc. 1982 Mar;57(3):145-8.
At the Mayo Clinic, 56 patients with infective endocarditis caused by gram-negative bacteria were seen from 1958 through 1979, 35 of whom were seen from 1970 through 1979. The patients were categorized into two divisions: those with medical, naturally acquired valve infections (40 [71%]) and those with infective endocarditis after cardiac operation (16 [29%]). The overall cure rate was 82% (46 of 56 patients); 35 of 40 patients (88%) were cured in the medical group, and 11 of 16 patients (69%) were cured in the surgical group. The patients were further classified on the basis of organism: group 1 (33 patients)--infections caused by Haemophilus (18), Actinobacillus actinomycetemcomitans (4), Cardiobacterium hominis (6), Eikenella corrodens (2), Kingella kingii (2), and Bordetella bronchiseptica (1); 32 of these 33 patients (97%) were cured, and 6 of these infections were on prosthetic valves; group 2 (21 patients)--infections caused by enteric aerobic bacilli; 13 of the 21 patients (62%) were cured; group 3 (1 patient)--infection caused by anaerobes (Bacteroides fragilis); this patient died; and group 4 (1 patient)--infection caused by Neisseria gonorrhoeae; this patient was cured. The gram-negative bacteria in the survivors and nonsurvivors and the curative antibiotic regimens were tabulated. Among the 35 survivors in the medical group, a combined antibiotic regimen cured 21 patients (60%) and a single antibiotic agent cured 14 (40%). Among the 11 survivors in the surgical group, combined therapy was given to 8 (73%), a single drug was used once, and operation alone achieved a cure in 2 patients. Compared with past data, the current study indicates an increasing incidence of gram-negative bacterial endocarditis (approximately 10%) and an improving cure rate 82%).
1958年至1979年期间，梅奥诊所共收治了56例由革兰氏阴性菌引起的感染性心内膜炎患者，其中35例是在1970年至1979年期间就诊的。这些患者被分为两组：患有医源性、自然获得性瓣膜感染的患者（40例[71%]）和心脏手术后发生感染性心内膜炎的患者（16例[29%]）。总体治愈率为82%（56例患者中的46例）；内科组40例患者中有35例（88%）治愈，外科组16例患者中有11例（69%）治愈。患者进一步根据病原体进行分类：第1组（33例患者）——由嗜血杆菌（18例）、伴放线放线杆菌（4例）、人心杆菌（6例）、腐蚀艾肯菌（2例）、金氏金杆菌（2例）和支气管败血波氏杆菌（1例）引起的感染；这33例患者中有32例（97%）治愈，其中6例感染发生在人工瓣膜上；第2组（21例患者）——由肠道需氧杆菌引起的感染；21例患者中有13例（62%）治愈；第3组（1例患者）——由厌氧菌（脆弱拟杆菌）引起的感染；该患者死亡；第4组（1例患者）——由淋病奈瑟菌引起的感染；该患者治愈。列出了存活者和非存活者体内的革兰氏阴性菌以及有效的抗生素治疗方案。在内科组的35名存活者中 ,联合抗生素治疗方案治愈了21例患者（60%），单一抗生素治愈了14例（40%）。在外科组的11名存活者中，8例（73%）接受了联合治疗，1例仅使用了一种药物，2例仅通过手术治愈。与过去的数据相比，当前研究表明革兰氏阴性菌性心内膜炎的发病率在上升（约10%），治愈率在提高（82%）。
