Lamas C C, Eykyn S J
Division of Infection, United Medical and Dental School, St Thomas's Hospital, London, UK.
Heart. 1998 May;79(5):442-7.
To analyse hospital acquired infective endocarditis cases with respect to age, sex, clinical, laboratory, and echocardiographic features, predisposition, complications, surgery, mortality, and diagnostic criteria.
Prospective cohort study.
Teaching hospital.
A series of 200 patients with infective endocarditis presenting over 11 years, 168 with native valve infective endocarditis, of whom 22 acquired this infection in hospital.
22 (14%) of the 168 cases of native valve infection were hospital acquired. The most common pathogens were staphylococci (77%). Two thirds of patients had no cardiac predisposition; one third had end stage renal disease. The most common source of infection was vascular access sites (73%). Eleven patients died. In 11 cases, infective endocarditis was proven pathologically (six at necropsy, five during surgery) and analysis of these showed that 45% were classed as probable by the Beth Israel criteria, 73% as definite by the Duke criteria, and 91% as definite by our suggested modifications of the Duke criteria. Figures for the 11 cases not proven pathologically were 27%, 73%, and 91%, respectively. Five of the 22 cases (22%) were rejected by the Beth Israel criteria but none were rejected by the Duke criteria with or without our modifications.
Hospital acquired infective endocarditis is difficult to diagnose. The Duke criteria have improved diagnostic sensitivity and our modifications have improved it further. Mortality is high but has been reduced by surgery. This serious infection could, in many cases, be prevented by improved care of intravascular lines and prompt removal when obviously infected.
分析医院获得性感染性心内膜炎病例的年龄、性别、临床、实验室及超声心动图特征、易患因素、并发症、手术情况、死亡率及诊断标准。
前瞻性队列研究。
教学医院。
11年间收治的200例感染性心内膜炎患者，其中168例为自体瓣膜感染性心内膜炎，22例在医院获得该感染。
168例自体瓣膜感染病例中有22例（14%）为医院获得性感染。最常见的病原体是葡萄球菌（77%）。三分之二的患者无心脏易患因素；三分之一患有终末期肾病。最常见的感染源是血管通路部位（73%）。11例患者死亡。11例经病理证实为感染性心内膜炎（6例尸检，5例手术中），分析显示，根据贝斯以色列标准，45%为可能病例，根据杜克标准，73%为确诊病例，根据我们对杜克标准的建议修改，91%为确诊病例。11例未经病理证实的病例的相应数字分别为27%、73%和91%。22例病例中有5例（22%）被贝斯以色列标准排除，但无论有无我们的修改，均无病例被杜克标准排除。
医院获得性感染性心内膜炎难以诊断。杜克标准提高了诊断敏感性，我们的修改进一步提高了诊断敏感性。死亡率很高，但手术降低了死亡率。在许多情况下，通过改善血管内导管护理并在明显感染时及时拔除，可以预防这种严重感染。
