Watanakunakorn C
Department of Internal Medicine, St Elizabeth Hospital Medical Center, Youngstown, Ohio.
Arch Intern Med. 1994 Oct 24;154(20):2330-5.
The clinical diagnosis of infective endocarditis due to Staphylococcus aureus can be difficult, and many patients with this disease are only diagnosed post mortem. There are few published reports of large series of patients with S aureus endocarditis and none from a community hospital. I reviewed the clinical and laboratory findings of a large number of patients with S aureus endocarditis in a community hospital.
I reviewed medical records identified through consultation records, International Classification of Diseases, Ninth Edition codes, and autopsy records of patients who fulfilled the criteria for the diagnosis of S aureus endocarditis during 1980 to 1991.
During the 12-year period, there were 106 cases, for a prevalence of 0.34 per 1000 admissions. Ninety-three (87.7%) of these patients were seen by me. The patients' ages ranged from 12 to 83 years (median, 61 years). Eighteen cases were nosocomial (15 were associated with intravascular catheters). Twenty-one patients were injecting drug users. Severe back pain was the chief complaint in nine patients. Twenty-seven patients had no heart murmur at the time of diagnosis. The overall mortality was 25.5%.
Age 60 years or older, female gender, community-acquired infection, absence of heart murmur, presence of congestive heart failure, or central nervous system involvement was associated with higher mortality. Tricuspid valve endocarditis alone was associated with lower mortality.
金黄色葡萄球菌所致感染性心内膜炎的临床诊断可能存在困难，许多患有这种疾病的患者仅在死后才得以确诊。关于大量金黄色葡萄球菌性心内膜炎患者的已发表报告很少，且没有来自社区医院的报告。我回顾了一家社区医院大量金黄色葡萄球菌性心内膜炎患者的临床和实验室检查结果。
我回顾了通过会诊记录、国际疾病分类第九版编码以及尸检记录确定的1980年至1991年期间符合金黄色葡萄球菌性心内膜炎诊断标准的患者的病历。
在这12年期间，共有106例病例，每1000例入院患者中的患病率为0.34。其中93例（87.7%）患者由我诊治。患者年龄范围为12岁至83岁（中位数为61岁）。18例为医院获得性感染（15例与血管内导管相关）。21例患者为注射吸毒者。9例患者的主要症状为严重背痛。27例患者在诊断时无心脏杂音。总体死亡率为25.5%。
60岁及以上、女性、社区获得性感染、无心脏杂音、存在充血性心力衰竭或中枢神经系统受累与较高死亡率相关。单纯三尖瓣心内膜炎与较低死亡率相关。
