Llinares Mondéjar P, Núñez Fernández M, Cordero Lorenzana L, Pereira Santelesforo S, Romero Picos E, Moure Crespo R
Unidad de Enfermedades Infecciosas, Hospital Juan Canalejo, La Coruña.
Rev Clin Esp. 1997 Dec;197(12):814-8.
Infective endocarditis is a complication of nosocomial bacteremia and is associated with a high mortality rate. The objective of the present study was to know the clinical and microbiological characteristics of nosocomial endocarditis (NE) diagnosed in a general hospital in a five-year period.
Twenty-one patients diagnosed of NE following Durack's criteria at Juan Canalejo Hospital from January 1990 to January 1995 were studied. Endocarditis in patients with cardiac valve prosthesis were excluded.
NE represented 12% of the total endocarditis cases diagnosed during the study period. The mean age of patients was 52.6 years (range: 17-79 years) and male accounted for 81% of cases. NE was related to an intravascular catheter in 85.7% of cases, whereas a urinary source was found in 14.3%. Staphylococcus aureus was the microorganism recovered most frequently (62%), followed by Staphylococcus epidermidis (20%), which was always associated with intravascular catheters. Left valve involvement predominated (76.2%) and the involvement of right cavities was detected exclusively in patients with an intravascular catheter as known source of NE. Transoesophageal echocardiography detected vegetations in 19% of cases in which transthoracic echography failed to identify them. Surgery was required by 28.5% of patients and its indication was always congestive heart failure refractory to medical treatment. The overall mortality rate was 28.5%, compared with 26.8% in community acquired endocarditis. Two patients with Candida spp. endocarditis were not treated surgically and the outcome was satisfactory.
Nosocomial endocarditis represent a significant percentage of endocarditis once endocarditis on prosthetic cardiac valves has been excluded. To remark Staphylococcus spp. in the etiology of this entity, the intravascular catheter as risk factor, and left cavities as location. Transoesophageal echocardiography is of great diagnostic usefulness. In contrast with reports in literature, the mortality rate in our series was similar to that of community endocarditis.
感染性心内膜炎是医院获得性菌血症的一种并发症，且死亡率较高。本研究的目的是了解一家综合医院在五年期间诊断出的医院内感染性心内膜炎（NE）的临床和微生物学特征。
对1990年1月至1995年1月在胡安·卡纳莱霍医院根据杜拉克标准诊断为NE的21例患者进行了研究。排除心脏瓣膜置换术后患者的心内膜炎。
NE占研究期间诊断出的所有心内膜炎病例的12%。患者的平均年龄为52.6岁（范围：17 - 79岁），男性占病例的81%。85.7%的NE病例与血管内导管相关，而14.3%的病例源于泌尿系统。金黄色葡萄球菌是最常分离出的微生物（62%），其次是表皮葡萄球菌（20%），后者总是与血管内导管相关。左心瓣膜受累为主（76.2%），右心腔受累仅在已知NE源为血管内导管的患者中检测到。经食管超声心动图在19%经胸超声心动图未能识别赘生物的病例中检测到了赘生物。28.5%的患者需要手术治疗，其指征始终是药物治疗难以控制的充血性心力衰竭。总体死亡率为28.5%，而社区获得性心内膜炎的死亡率为26.8%。两名念珠菌属心内膜炎患者未接受手术治疗，结果令人满意。
一旦排除人工心脏瓣膜的心内膜炎，医院内感染性心内膜炎在所有心内膜炎病例中占相当比例。需注意该疾病病因中的葡萄球菌属、作为危险因素的血管内导管以及作为发病部位的左心腔。经食管超声心动图具有很大的诊断价值。与文献报道相反，我们系列研究中的死亡率与社区获得性心内膜炎相似。
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