Aguado J M, Casillas A, Lizasoaín M, Lumbreras C, Peña C, Martín-Durán R, Fernández-Viladrich P, Fernández-Guerrero M L, Noriega A R
Unidad de Enfermedades Infecciosas, Servicio de Microbiologia, Hospital 12 de Octubre, Madrid.
Med Clin (Barc). 1993 Mar 6;100(9):325-8.
To evaluate the clinic characteristics and therapeutic aspects of endocarditis by Streptococcus pneumoniae sensitive and resistant to penicillin.
Twelve cases of pneumococcal endocarditis evaluated in 4 Spanish hospitals over the last 10 years were studied, analyzing their clinical characteristics and the existence of resistance to penicillin. The features were compared with a series of 98 cases found in a review of the literature.
All the patients were males, most being alcoholics. The course of the disease was acute (2 weeks) in all the cases and evolved with great aggressivity: cardiac failure (9 patients), myocardial abscess (7 patients), multiple arterial embolisms (5 patients), septic arthritis (4 patients). Three patients had simultaneous pneumococcal meningitis but only one had pneumonia. The valve most affected was the aortic (9 cases). Three cases were due to strains of Streptococcus pneumoniae with moderate resistance to penicillin (CMI 0.5-1 micrograms/ml). Global mortality was 42%. All the patients receiving inadequate antibiotic treatment died. Vancomycin and cefotaxime appear to be effective in the treatment of cases produced by strains of pneumococcus with intermediate sensitivity to penicillin. There were no apparent differences in mortality between the cases of endocarditis by pneumococcus sensitive or moderately resistant to penicillin.
Pneumococcal endocarditis continues to condition a high mortality similar to that produced in previously made series. The classic relation with meningitis and pneumonia is infrequent today. The appearance of strains resistant to penicillin may increase the incidence of this infection and further worsen prognosis.
评估对青霉素敏感和耐药的肺炎链球菌所致心内膜炎的临床特征及治疗情况。
研究了过去10年在4家西班牙医院评估的12例肺炎球菌性心内膜炎病例，分析其临床特征及对青霉素的耐药情况。将这些特征与文献综述中发现的98例病例系列进行比较。
所有患者均为男性，多数为酗酒者。所有病例的病程均为急性（2周），且进展极为迅速：心力衰竭（9例）、心肌脓肿（7例）、多发性动脉栓塞（5例）、化脓性关节炎（4例）。3例患者同时患有肺炎球菌性脑膜炎，但仅1例有肺炎。最常受累的瓣膜是主动脉瓣（9例）。3例由对青霉素中度耐药的肺炎链球菌菌株引起（最低抑菌浓度0.5 - 1微克/毫升）。总体死亡率为42%。所有接受不充分抗生素治疗的患者均死亡。万古霉素和头孢噻肟似乎对治疗由对青霉素中度敏感的肺炎球菌菌株引起的病例有效。对青霉素敏感或中度耐药的肺炎球菌所致心内膜炎病例的死亡率无明显差异。
肺炎球菌性心内膜炎的死亡率仍然很高，与先前系列研究的结果相似。如今，与脑膜炎和肺炎的经典关联并不常见。对青霉素耐药菌株的出现可能会增加这种感染的发生率，并进一步恶化预后。
