Pazin G J, Peterson K L, Griff F W, Shaver J A, Ho M
Ann Intern Med. 1975 Jun;82(6):746-50. doi: 10.7326/0003-4819-82-6-746.
Medical-surgical treatment of antibiotic refractory endocarditis requires determination of the site of infection, which is not always possible with conventional cardiac catheterization. The cases of two patients with right-sided endocarditis who survived after combined medical-surgical therapy are presented. One had persistent Pseudomonas aeruginosa bacteremia and three possible sites of infection. Multiple quantitative blood cultures proximal and distal to each suspected site indicated the pulmonary valve alone was infected. The second had sustained bacteremia with three enteric organisms and no apparent valvular abnormality. Quantitative cultures excluded the abdomen as the continuing source of bacteremia and suggested the tricuspid valve was infected. This was confirmed by a second catheterization using multiple cultures in conjuction with dye dilution studies, intracardiac phonocardiography, and angiography. These bacteriologic and cardiologic techniques may be especially useful in detecting right-sided endocarditis and may also be helpful in detecting concomitant infection of both sides of the heart.
抗生素难治性心内膜炎的内科-外科治疗需要确定感染部位，而传统的心导管检查并非总能做到这一点。本文介绍了两名右侧心内膜炎患者在联合内科-外科治疗后存活的病例。其中一名患者持续存在铜绿假单胞菌菌血症，有三个可能的感染部位。对每个疑似部位近端和远端进行的多次定量血培养表明，仅肺动脉瓣受到感染。另一名患者持续菌血症，感染三种肠道菌，且无明显瓣膜异常。定量培养排除了腹部作为持续菌血症来源，提示三尖瓣受到感染。这一点通过第二次心导管检查得到证实，该检查结合了多次培养、染料稀释研究、心内心音图和血管造影。这些细菌学和心脏病学技术在检测右侧心内膜炎方面可能特别有用，也有助于检测心脏两侧的合并感染。
