Chen T T, Schapiro J M, Loutit J
Stanford University School of Medicine, California 94305, USA.
J Cardiovasc Surg (Torino). 1996 Dec;37(6):631-3.
Prosthetic valve endocarditis is a potential complication of valve replacement surgery and warrants prompt diagnosis and appropriate treatment. Thus, the blood culture in addition to providing an etiological organism is important in establishing appropriate antibiotic therapy. A case of prosthetic valve endocarditis (PVE) is presented with repeatedly negative blood cultures at a community hospital and refractory to prolonged therapy with standard antibiotic regimens. Appropriate workup eventually identified the causative organism as Legionella pneumophila, and antimicrobial therapy directed against Legionella combined with a repeat valve replacement effectively treated this case. Aspects of culture-negative PVE including the microbiology and etiology are discussed. Legionella endocarditis represents an important cause of culture negative PVE and should be considered in the differential diagnosis of culture negative PVE refractory to standard antimicrobial therapy.
人工瓣膜心内膜炎是瓣膜置换手术的一种潜在并发症，需要及时诊断和恰当治疗。因此，血培养除了能提供病原体外，对于确定合适的抗生素治疗也很重要。本文报告一例社区医院的人工瓣膜心内膜炎（PVE）病例，其血培养多次呈阴性，且对标准抗生素方案的长期治疗无效。经过适当检查最终确定病原体为嗜肺军团菌，针对军团菌的抗菌治疗联合再次瓣膜置换有效地治愈了该病例。文中讨论了血培养阴性PVE的相关方面，包括微生物学和病因。军团菌性心内膜炎是血培养阴性PVE的一个重要原因，在对标准抗菌治疗无效的血培养阴性PVE的鉴别诊断中应予以考虑。
