Petheram I S, Boyce J M
Thorax. 1977 Aug;32(4):478-85. doi: 10.1136/thx.32.4.478.
, , 478-485. Twenty-four episodes of prosthetic valve endocarditis occurred in 23 patients in a 10-year period. Fifteen patients presented within four months and nine from 14 months to seven years after surgery. The commonest pathogens in the early group were (five), but in three of these patients other organisms were found; diphtheroid species in five and in three. Four patients in the late group had infection. Antistaphylococcal operative prophylaxis has been successful, but opportunist organisms of low virulence in health have emerged as pathogens. Continuous monitoring of antibiotic prophylaxis may reduce the incidence of early cases, and antibiotic cover for dental procedures should be as meticulous after valve replacement as before operation. The most frequent cause of death in both groups was delayed or inadequate treatment because of failure to isolate the pathogens from blood cultures with consequent severe haemodynamic upset or uncontrolled infection. Previous courses of antibiotics were the usual reason for negative blood cultures. Successful management requires close liaison with an interested clinical bacteriologist and aggressive surgery for haemodynamic faults or failure to control infection.
在10年期间，23例患者发生了24次人工瓣膜心内膜炎。15例患者在术后4个月内发病，9例在术后14个月至7年发病。早期组最常见的病原体是葡萄球菌（5例），但其中3例患者还发现了其他病原体；类白喉菌5例，肠球菌3例。晚期组4例患者发生真菌性感染。抗葡萄球菌手术预防措施取得了成功，但健康状态下低毒力的机会致病菌已成为病原体。持续监测抗生素预防措施可能会降低早期病例的发生率，瓣膜置换术后牙科操作的抗生素覆盖应与手术前一样细致。两组中最常见的死亡原因是由于未能从血培养中分离出病原体，导致严重血流动力学紊乱或感染无法控制，从而延误或治疗不当。先前使用抗生素的疗程是血培养阴性的常见原因。成功的治疗需要与感兴趣的临床细菌学家密切联系，并对血流动力学故障或感染无法控制进行积极的手术治疗。
