Blatter M, Frei R, Zimmerli W
Departement für Innere Medizin und Bakteriologisches Labor, Universitätskliniken, Kantonsspital Basel.
Praxis (Bern 1994). 1994 Nov 22;83(47):1324-31.
The response of infective endocarditis to antimicrobial therapy is slow because host defence mechanisms in heart valves are absent, high bacterial densities occur in vegetations and the infecting agents have a low metabolic activity. In this situation, only an optimal antibiotic treatment can be effective; therefore early identification of the microorganism by means of blood cultures and the use of bactericidal antibiotics with proven efficacy in clinical trials are essential. The antibiotics should be administered intravenously, because constant and high serum levels are important. The choice of the empirical therapy is based on the patient's history, on clinical signs and symptoms as well as on some additional examinations in order to define the most probable organisms involved. As soon as the infecting agent is identified, the treatment should be optimized. A daily clinical examination of the patient and frequent laboratory controls are needed. In case of poor clinical response to the antimicrobial therapy, the search for complications is frequently more appropriate than changing the antibiotics. The duration of therapy depends on the infecting agent, the evolution and the antibiotic regimen that has been chosen. After treatment, blood cultures should be taken at four and eight weeks, since most relapses appear within this period.
感染性心内膜炎对抗菌治疗的反应缓慢，这是因为心脏瓣膜缺乏宿主防御机制，赘生物中细菌密度高，且感染病原体的代谢活性低。在这种情况下，只有优化抗生素治疗才可能有效；因此，通过血培养早期鉴定微生物以及使用在临床试验中已证实有效的杀菌性抗生素至关重要。抗生素应静脉给药，因为持续的高血清水平很重要。经验性治疗的选择基于患者病史、临床体征和症状以及一些其他检查，以便确定最可能涉及的病原体。一旦鉴定出感染病原体，就应优化治疗。需要对患者进行每日临床检查和频繁的实验室监测。如果对抗菌治疗的临床反应不佳，寻找并发症往往比更换抗生素更合适。治疗持续时间取决于感染病原体、病情进展以及所选择的抗生素治疗方案。治疗后，应在四周和八周时进行血培养，因为大多数复发发生在此期间。
