Dwyer D E, Chen S C, Wright E J, Crimmins D, Collignon P J, Sorrell T C
Centre for Infectious Diseases and Microbiology, University of Sydney, ICPMR, Westmead Hospital, NSW.
Med J Aust. 1994 Jun 6;160(11):709-13, 716-8.
To identify factors contributing to infective endocarditis at a major teaching hospital.
Retrospective review of clinical records of patients diagnosed with endocarditis by standard case definitions with respect to causative organisms, clinical features and outcome.
One hundred and ninety-three episodes of endocarditis seen between 1979 and 1992 at Westmead Hospital, Sydney, were reviewed. In the 174 cases where the causative organism was isolated, 75 (43%) were Staphylococcus aureus and 50 (29%) were viridans streptococci. Nosocomial acquisition and/or inter-hospital transfer accounted for 83 episodes; 48 (58%) S. aureus (P < 0.001) and nine (11%) viridans streptococci (P < 0.001). In cases from the local community, viridans streptococci were more common than S. aureus (37% versus 25%); these included 18 episodes (14 S. aureus) in intravenous drug users.
We conclude that, compared with community-acquired infections, the aetiology of endocarditis in a large teaching hospital is influenced strongly by the prevalence of nosocomial endocarditis and the need for interhospital transfer of complicated cases.
确定一家大型教学医院感染性心内膜炎的相关因素。
回顾性分析按照标准病例定义诊断为心内膜炎的患者的临床记录，内容涉及致病微生物、临床特征及转归。
对1979年至1992年悉尼韦斯特米德医院收治的193例心内膜炎病例进行了回顾。在174例分离出致病微生物的病例中，75例（43%）为金黄色葡萄球菌，50例（29%）为草绿色链球菌。医院获得性感染和/或院际转运导致83例发病；其中48例（58%）为金黄色葡萄球菌（P<0.001），9例（11%）为草绿色链球菌（P<0.001）。在来自当地社区的病例中，草绿色链球菌比金黄色葡萄球菌更常见（37%对25%）；其中包括18例静脉吸毒者发病（14例为金黄色葡萄球菌）。
我们得出结论，与社区获得性感染相比，大型教学医院心内膜炎的病因受医院内感染的发生率以及复杂病例院际转运需求的强烈影响。
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