静脉药物使用者感染性心内膜炎的临床特征、受累部位、细菌学检查结果及预后

Clinical features, site of involvement, bacteriologic findings, and outcome of infective endocarditis in intravenous drug users.

作者信息

Mathew J, Addai T, Anand A, Morrobel A, Maheshwari P, Freels S

机构信息

Department of Medicine, Cook County Hospital, Chicago, IL, USA.

出版信息

Arch Intern Med. 1995;155(15):1641-8.

PMID:7618988

Abstract

BACKGROUND

Intravenous drug use is an increasingly common condition predisposing to infective endocarditis. Data on infective endocarditis in intravenous drug users are limited.

OBJECTIVE

To determine the clinical features, bacteriologic findings, site of involvement, complications, and mortality associated with infective endocarditis in intravenous drug users.

METHODS

Cohort study of intravenous drug users with native valve infective endocarditis.

RESULTS

A total of 125 cases of infective endocarditis occurred in 114 patients (84 cases [67%] in men and 41 cases [32%] in women) with a mean (+/- SD) age of 37 +/- 7 years. The tricuspid valve was involved in 58 cases (46%), the mitral valve in 40 cases (32%), and the aortic valve in 24 cases (19%). The microorganisms identified included Staphylococcus in 82 cases (65.6%) and Streptococcus in 32 cases (25.6%). Twenty-three patients (18%) underwent surgery, and two (9%) of them died. One hundred two patients (82%) were treated medically, and nine (9%) of them died. Fifteen patients (63%) with aortic valve involvement vs 17 patients (17%) without aortic valve involvement underwent surgery or died without surgery (odds ratio, 8.24; 95% confidence interval, 3.1 to 21.8). Among the survivors, at least one major cardiovascular complication occurred in 79 cases (69.3%).

CONCLUSIONS

Infective endocarditis in intravenous drug users affects the right and left sides of the heart with approximately equal frequency. At present, more than 90% of cases of infective endocarditis in intravenous drug users in Chicago are caused by staphylococci or streptococci. Involvement of the aortic valve is predictive of increased morbidity and mortality in intravenous drug users with infective endocarditis. With medical treatment, and surgery when medical treatment fails, intravenous drug users with infective endocarditis have an in-hospital survival rate of 91%.

摘要

背景

静脉注射毒品是导致感染性心内膜炎的一种日益常见的情况。关于静脉注射毒品者感染性心内膜炎的数据有限。

目的

确定静脉注射毒品者感染性心内膜炎的临床特征、细菌学检查结果、受累部位、并发症及死亡率。

方法

对原发性瓣膜感染性心内膜炎的静脉注射毒品者进行队列研究。

结果

114例患者共发生125例感染性心内膜炎（男性84例[67%]，女性41例[32%]），平均（±标准差）年龄为37±7岁。三尖瓣受累58例（46%），二尖瓣受累40例（32%），主动脉瓣受累24例（19%）。鉴定出的微生物包括葡萄球菌82例（65.6%）和链球菌32例（25.6%）。23例患者（18%）接受了手术，其中2例（9%）死亡。102例患者（82%）接受药物治疗，其中9例（9%）死亡。主动脉瓣受累的15例患者（63%）与未累及主动脉瓣的17例患者（17%）接受了手术或未手术死亡（比值比，8.24；95%置信区间，3.1至21.8）。在幸存者中，79例（69.3%）至少发生了一种主要心血管并发症。