Llinares Mondéjar P, Castro Beiras A
Unidad de Enfermedades Infecciosas, Complejo Hospitalario Juan Canalejo, La Coruña.
Rev Esp Cardiol. 1998;51 Suppl 2:51-7.
Infectious endocarditis is an infection that is characterized by the presence of microorganisms in dense populations in vegetating lesions in the endocardium. Because phagocyte penetration to the interior of the vegetation is practically impossible, to cure infectious endocarditis, high doses of bactericidal antibiotics are administered, usually intravenously and for a long duration. In this article, antibiotic treatment is reviewed, depending on the isolated microorganism and in cases where necessary, treatment is initiated in an empirical manner. Once the microorganism was isolated, the recommended guidelines for antibiotic treatment have gone through some variations in recent years, due to the changing pattern of antibiotic sensitivity of some microorganisms, to the point of finding ourselves on occasion without an effective treatment (e.g. multiresistant enterococci). In addition, these variations are due to the introduction of new antibiotics that allow, in special cases, for the treatment to be administered on an outpatient basis. Using anticoagulation in infectious endocarditis is still considered controversial. In general, only patients having cardiac valvular prostheses seem to benefit from its use.
感染性心内膜炎是一种以内膜赘生物损伤部位存在大量微生物为特征的感染。由于吞噬细胞几乎不可能穿透到赘生物内部,为治愈感染性心内膜炎,通常需要静脉注射大剂量杀菌性抗生素并持续较长时间。在本文中,将根据分离出的微生物对抗生素治疗进行综述,必要时以经验性方式开始治疗。一旦分离出微生物,由于某些微生物对抗生素敏感性模式的变化,近年来抗生素治疗的推荐指南出现了一些变化,以至于有时我们会发现没有有效的治疗方法(例如多重耐药肠球菌)。此外,这些变化还归因于新抗生素的引入,在特殊情况下,这些新抗生素可使治疗在门诊进行。在感染性心内膜炎中使用抗凝治疗仍存在争议。一般来说,似乎只有患有心脏瓣膜假体的患者能从中受益。