Francioli P
Division of Hospital Preventative Medicine, Centre Hospitalier Universitaire, Vaudois, Lausanne, Switzerland.
Eur Heart J. 1995 Apr;16 Suppl B:75-9. doi: 10.1093/eurheartj/16.suppl_b.75.
The management of streptococcal and enterococcal endocarditis has changed in recent years with the development of effective new regimens that are easier to administer, but resistance to commonly used antibiotics has appeared, especially among enterococci. Beta-lactam antibiotics either alone or in combination are suitable for most patients with viridans streptococci. Streptococci bovis, and S. pneumoniae, but alternative regimens are necessary for special situations. Group B, C and G streptococci respond best to the combination of a penicillin and an aminoglycoside. Enterococci are relatively resistant to penicillins and cephalosporins and strains resistant to beta-lactams, glycopeptides and aminoglycosides have become more common lately. Strategies are proposed dependent on the resistance of the organisms, but it is recognized that medical failure is not uncommon and surgical removal of the infected valve may be the only curative treatment.
近年来，随着易于给药的有效新治疗方案的出现，链球菌和肠球菌性心内膜炎的管理发生了变化，但对常用抗生素的耐药性已经出现，尤其是在肠球菌中。β-内酰胺类抗生素单独使用或联合使用适用于大多数感染草绿色链球菌、牛链球菌和肺炎链球菌的患者，但特殊情况需要替代方案。B组、C组和G组链球菌对青霉素和氨基糖苷类药物联合使用反应最佳。肠球菌对青霉素和头孢菌素相对耐药，对β-内酰胺类、糖肽类和氨基糖苷类耐药的菌株最近变得更加常见。根据病原体的耐药性提出了相应策略，但人们认识到治疗失败并不罕见，手术切除感染瓣膜可能是唯一的治愈性治疗方法。
