抗生素治疗对感染性心内膜炎赘生物大小及并发症发生率的影响。
Effect of antibiotic treatment on vegetation size and complication rate in infective endocarditis.
作者信息
Rohmann S, Erhel R, Darius H, Makowski T, Meyer J
机构信息
2nd Medical Clinic, University of Mainz, Germany.
出版信息
Clin Cardiol. 1997 Feb;20(2):132-40. doi: 10.1002/clc.4960200210.
BACKGROUND
Infective endocarditis is associated with significant morbidity and mortality, with valvular destruction, and with congestive heart failure. Embolic events are more common in patients with echocardiographically discernible vegetations, especially when vegetations are > 10 mm in diameter.
HYPOTHESIS
The objective of the study was to follow vegetation morphology during native valve endocarditis, to compare it with the clinical course and antibiotic treatment chosen, and to evaluate whether the impact on vegetation size and complication rate of antibiotic regimens differed in patients with positive and negative blood cultures.
METHODS
The effect of different antibiotic regimes on vegetation size monitored by using transesophageal echocardiography was evaluated in 183 patients with echocardiographic evidence of infective endocarditis. A total of 223 vegetations attached to the aortic or mitral valves were detected using the transesophageal approach. The patients were followed for a mean of 76 weeks and underwent a minimum of two consecutive transesophageal echocardiographic examinations.
RESULTS
Treatment with different kinds of antibiotics corresponded with significant differences in vegetation size; vancomycin-associated treatment was related to a 45% reduction, ampicillin to a 19% reduction, penicillin to a 5% reduction, penicillase-resistant drugs to a 15% increase, and cephalosporin to a 40% increase in vegetation size. Multivariate analysis showed that penicillin, cephalosporin, and penicillase-resistant drug treatments were associated with an increased embolic risk, vancomycin treatment with abscess formation, and cephalosporin medication with increased mortality. Plotting changes in vegetation size against the incidence of embolism and mortality, linear regression analysis suggested a 40-50% reduction in vegetation size, thereby greatly reducing the risk of embolism and mortality.
CONCLUSION
Our study shows that different antibiotics have different effects on vegetation size. The highest complication rate was observed when vegetations significantly increased in size during antibiotic treatment. Especially in culture-negative patients, monitoring vegetation size by means of transesophageal echocardiography may prove to be useful for estimating the efficacy of antibiotic treatment.
背景
感染性心内膜炎与显著的发病率和死亡率、瓣膜破坏以及充血性心力衰竭相关。在经超声心动图可识别赘生物的患者中，栓塞事件更为常见，尤其是当赘生物直径>10mm时。
假设
本研究的目的是追踪自体瓣膜心内膜炎期间赘生物的形态，将其与临床病程及所选抗生素治疗进行比较，并评估血培养阳性和阴性患者中抗生素方案对赘生物大小及并发症发生率的影响是否存在差异。
方法
采用经食管超声心动图评估183例有感染性心内膜炎超声心动图证据的患者中不同抗生素方案对赘生物大小的影响。经食管超声心动图共检测到223个附着于主动脉瓣或二尖瓣的赘生物。患者平均随访76周，至少接受连续两次经食管超声心动图检查。
结果
不同种类抗生素治疗与赘生物大小存在显著差异；万古霉素相关治疗使赘生物大小减少45%，氨苄西林使其减少19%，青霉素使其减少5%，耐青霉素酶药物使其增加15%，头孢菌素使其增加40%。多因素分析显示，青霉素、头孢菌素和耐青霉素酶药物治疗与栓塞风险增加相关，万古霉素治疗与脓肿形成相关，头孢菌素用药与死亡率增加相关。将赘生物大小变化与栓塞和死亡率发生率进行绘图，线性回归分析表明赘生物大小减少40 - 50%，从而大大降低了栓塞和死亡风险。
结论
我们的研究表明不同抗生素对赘生物大小有不同影响。抗生素治疗期间赘生物大小显著增加时并发症发生率最高。尤其是在血培养阴性的患者中，通过经食管超声心动图监测赘生物大小可能有助于评估抗生素治疗的疗效。
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