CAJ | 학술논문

目的了解感染性心内膜炎(IE)的临床表现、病原谱特征、耐药状况及预后影响因素.方法收集复旦大学附属中山医院2011年1月-2013年1月确诊和临床诊断的IE患者的临床及病原学资料,统计病原体构成和对药物的敏感性,使用单因素和多因素回归分析确定影响预后的危险因素.结果共收集218例IE,其中确诊91例,临床诊断127例;男148例,女70例,年龄(46.0±14.6)岁.209例(95.9％)为自体瓣膜IE,9例(4.1％)为人工瓣膜IE.95例(43.6％)伴有心脏基础疾病,其中,先天性心脏病72例(33.0％),风湿性心脏病23例(10.6％).171例(78.4％)患者超声心动图检出赘生物.84例(38.5％)检出病原体,以草绿色链球菌最多,占63.1％,其次为金黄色葡萄球菌(13.1％)和粪肠球菌(4.8％).药敏结果显示,受试的草绿色链球菌对青霉素的敏感率7/11,对三代或四代头孢菌素、万古霉素和利奈唑胺均敏感.180例(82.6％)行手术治疗.住院期间共死亡7例,住院病死率3.2％.单因素回归分析显示,IE死亡危险因素为医疗相关感染、人工瓣膜、中重度贫血(Hb ＜90 g/L)和胸闷或胸痛,而保护因素为手术治疗.多因素回归分析显示,医疗相关感染(OR=17.03,95％ CI 1.76～164.75,P=0.014)和中重度贫血(Hb ＜90 g/L)(OR=13.47,95％CI2.46～73.60,P=0.003)是引起IE死亡的相关危险因素,而手术治疗(OR =0.17,95％ CI0.03～0.97,P=0.047)是IE死亡的保护因素.结论 IE的病原菌仍以草绿色链球菌最多见,但菌种呈现多样化趋势,草绿色链球菌对青霉素的敏感性低.医疗相关感染和中重度贫血是IE预后不良的独立危险因素,手术治疗是重度IE预后的保护性因素.
목적 료해감염성심내막염(IE)적림상표현、병원보특정、내약상황급예후영향인소.방법 수집복단대학부속중산의원2011년1월-2013년1월학진화림상진단적IE환자적림상급병원학자료,통계병원체구성화대약물적민감성,사용단인소화다인소회귀분석학정영향예후적위험인소.결과 공수집218례IE,기중학진91례,림상진단127례;남148례,녀70례,년령(46.0±14.6)세.209례(95.9％)위자체판막IE,9례(4.1％)위인공판막IE.95례(43.6％)반유심장기출질병,기중,선천성심장병72례(33.0％),풍습성심장병23례(10.6％).171례(78.4％)환자초성심동도검출췌생물.84례(38.5％)검출병원체,이초록색련구균최다,점63.1％,기차위금황색포도구균(13.1％)화분장구균(4.8％).약민결과현시,수시적초록색련구균대청매소적민감솔7/11,대삼대혹사대두포균소、만고매소화리내서알균민감.180례(82.6％)행수술치료.주원기간공사망7례,주원병사솔3.2％.단인소회귀분석현시,IE사망위험인소위의료상관감염、인공판막、중중도빈혈(Hb ＜90 g/L)화흉민혹흉통,이보호인소위수술치료.다인소회귀분석현시,의료상관감염(OR=17.03,95％ CI 1.76～164.75,P=0.014)화중중도빈혈(Hb ＜90 g/L)(OR=13.47,95％CI2.46～73.60,P=0.003)시인기IE사망적상관위험인소,이수술치료(OR =0.17,95％ CI0.03～0.97,P=0.047)시IE사망적보호인소.결론 IE적병원균잉이초록색련구균최다견,단균충정현다양화추세,초록색련구균대청매소적민감성저.의료상관감염화중중도빈혈시IE예후불량적독립위험인소,수술치료시중도IE예후적보호성인소.
Objective To describe the profile of patients with infective endocarditis (IE) and assess prognostic factors of IE.Methods Clinical and etiology data of 218 patients with IE were collected retrospectively from January 2011 to January 2013.The distribution and antimicrobial susceptibilities of pathogens causing IE were evaluated.Prognostic factors associated with IE were determined by univariate and multivariate regression analysis.Results There were 148 men and 70 women with age of (46.0 ± 14.6)years.Ninety-five (43.6％) of them had heart diseases,including 72 cases (33.0％) of congenital heart disease and 23 cases (10.6％) of chronic rheumatic heart disease.Vegetations were detected by echocardiography in 171 (78.4％) patients.Microorganisms causing IE were identified in 84 cases (38.5％) cases.Streptococcus viridans was the dominant pathogen,accoumed for 63.1％ of all the pathogens,followed by Staphylococcus (13.1％) and Enterococcus (4.8％).Totally 7/11 Streptococcus viridans was susceptible to penicillin,while 100％ susceptible to the third and fourth generation cephalosporins,vancomycin and linezolid.One hundred and eighty cases underwent operations.The in-hospital mortality rate of IE was 3.2％.In univariate regression,health care-associated infection,prosthetic valve,anemia and chest symptoms (distress or pain) were related to the increased risk of mortality in patients with IE,while surgery appeared to be a protective factor.In the logistic regression model,the variables significantly associated with IE prognosis were health care-associated infection (OR =17.03,95％ CI 1.76-164.75,P =0.014) and anemia (Hb ＜ 90 g/L) (OR =13.47,95％ CI 2.46-73.60,P =0.003) and surgery treatment (OR =0.17,95％ CI 0.03-0.97,P =0.047).Conclusions Although Streptococcus viridans is the most common pathogen causing IE,the pathogens of IE become versatile.The antibacterial activity of penicillin against Streptococcus viridans is low.Health care-associated infection and anemia are risk factors of IE prognosis,while surgery treatment is a protective factor of severe IE.