Carton J A, Asensi V, Maradona J A, Segovia E, Simarro C, Pérez González F, Arribas J M
Servicio de Medicina Interna (Enfermedades Infecciosas), Hospital Central de Asturias (Hospital Nuestra Señora de Covadonga), Oviedo, Asturias.
Med Clin (Barc). 1995 Apr 8;104(13):493-9.
The description of the epidemiologic profile and analysis of the mortality of infectious endocarditis (IE) observed from 1984-1993.
One hundred thirty episodes of IE in a native valve (30 in drug addicts [IVDA] and 20 cases of nosocomial acquisition) were analyzed with right/left/bilateral localization (42/84/4, respectively), infection of the mitral/aortic/tricuspid valve (52/47/34, respectively) and the etiology was determined as Staphylococcus aureus in 52 cases, 41 Streptococcus, 13 negative coagulase Staphylococcus, and 11 Enterococcus. High risk IE were identified by uni and multivariate analysis (MVA).
The incidence of IE ranged from 0.36 and 0.70 cases x 1.000 admitted adults/year (mean: 0.50). Transthoracic echocardiography detected bacterial vegetations in 67% of the cases with the validity to predict the development of embolisms being 55%. MVA showed the embolic episodes (present in 45% of the IE) to be associated with the IVDA patients and prolonged fever. The latter complication, being defined as > or = 10 days of fever under appropriate treatment, was observed in 32% of the cases and was due to mild (n = 15) and severe causes (n = 27). Postembolic septic complications were associated to fever with MVA. Twenty three patients died (18%), 2 IVDA and 5 nosocomial IE, mainly due to heart failure (n = 13). The independent risk factor predictors for death (p < 0.05) were: age > or = 60 years (mortality 34%), cerebral embolisms (55%), severe heart failure (37%), and the exclusion of the patient as a candidate for surgery (73%). To the contrary, right IE (mortality 0%) and cardiac surgery (5%) favoured survival.
To improve the prognosis of infectious endocarditis in high risk patients more opportune cardiac surgery accepting greater risks should be performed.
对1984年至1993年期间观察到的感染性心内膜炎（IE）的流行病学特征及死亡率进行描述和分析。
分析了130例天然瓣膜IE发作病例（30例为吸毒者[IVDA]，20例为医院获得性感染），按右/左/双侧定位（分别为42/84/4）、二尖瓣/主动脉瓣/三尖瓣感染（分别为52/47/34）进行分析，病因确定为金黄色葡萄球菌52例、链球菌41例、凝固酶阴性葡萄球菌13例、肠球菌11例。通过单因素和多因素分析（MVA）确定高危IE。
IE的发病率为每年0.36至0.70例/1000名入院成人（平均：0.50）。经胸超声心动图在67%的病例中检测到细菌性赘生物，预测栓塞发生的有效性为55%。MVA显示栓塞发作（在45%的IE中出现）与IVDA患者及长期发热有关。后一种并发症定义为在适当治疗下发热≥10天，在32%的病例中观察到，原因包括轻度（n = 15）和重度（n = 27）。栓塞后败血症并发症与MVA中的发热有关。23例患者死亡（18%），2例IVDA和5例医院获得性IE，主要死于心力衰竭（n = 13）。死亡的独立危险因素预测因素（p < 0.05）为：年龄≥60岁（死亡率34%）、脑栓塞（55%）、严重心力衰竭（37%）以及患者被排除在手术候选之外（73%）。相反，右心IE（死亡率0%）和心脏手术（5%）有利于生存。
为改善高危患者感染性心内膜炎的预后，应进行更适时、接受更大风险的心脏手术。
