The Changing Face of Prosthetic Valve Endocarditis at a Tertiary-Care Hospital: 1986-2005
The Changing Face of Prosthetic Valve Endocarditis at a Tertiary-Care Hospital: 1986-2005
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DOI：
10.1016/s0300-8932(10)70006-3
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发表时间：
2010-01-01
影响因子：
5.9
通讯作者：
Carmen Farinas, Maria
中科院分区：
文献类型：
--
作者：
Alonso-Valle, Hector;Farinas-Alvarez, Concepcion;Carmen Farinas, Maria
导言和目标。研究三级医院人工瓣膜心内膜炎的临床特征、病因和预后变化。对1986年至2005年期间采用改良杜克标准诊断为人工瓣膜心内膜炎的所有患者进行的回顾性队列研究。分析涵盖两个时间段：1986年1月至1995年12月（P1）和1996年1月至2005年12月（P2）。122例患者共发生133次心内膜炎。其中P1诊断73例（54.9%），P2诊断60例（45.1%），发生率分别为2.19%和2.18%。P1患者的平均年龄（SD）为52.6 ± 16.6岁，P2患者的平均年龄为66.2 ± 11.5岁（P=.0001）。两个研究阶段的临床特征相似。肠球菌感染显著增加（P2中12.5% vs. P1中4.9%;相对风险[RR]=2.5; 95%置信区间[CI]，0.7-9.6），草绿色链球菌感染显著减少（P2中12.5% vs. P1中31.1%; RR=0.4; 95% CI，0.2-0.9）。约90.4%的患者（63/73）在P1接受了手术，而68.3%（41/60）在P2接受了手术。差异具有显著性（RR=0.8; 95%CI，0.6-0.9）。住院死亡率P1为28.8%，P2为30%（RR=1; 95%CI，0.6-1.7）。在20年的研究期间，观察到人工瓣膜心内膜炎的流行病学和微生物病因学的变化。诊断和治疗方法也发生了变化，但死亡率仍然很高。
Introduction and objectives. To investigate changes in the clinical characteristics, etiology and prognosis of prosthetic valve endocarditis at a tertiary-care hospital.Methods. Retrospective cohort study of all patients diagnosed with prosthetic valve endocarditis using modified Duke criteria between 1986 and 2005. The analysis covered two time periods: January 1986 to December 1995 (P1) and January 1996 to December 2005 (P2).Results. In total, 133 episodes of endocarditis occurred in 122 patients. Of these, 73 (54.9%) were diagnosed in P1 and 60 (45.1%) in P2, with incidences of 2.19% and 2.18%, respectively. The patients' mean age (SD) was 52.6 +/- 16.6 years in P1 and 66.2 +/- 11.5 years in P2 (P=.0001). Clinical characteristics were similar in the two study periods. The increase in Enterococcus infection was remarkable (12.5% in P2 vs. 4.9% in P1; relative risk [RR]=2.5; 95% confidence interval [CI], 0.7-9.6), as was the decrease in viridans group Streptococcus infection (12.5% in P2 vs. 31.1% in P1; RR=0.4; 95% CI, 0.2-0.9). Some 90.4% of patients (63/73) underwent surgery in P1, while 68.3% (41/60) underwent surgery in P2. The difference was significant (RR=0.8; 95% CI, 0.6-0.9). The in-hospital mortality rate was 28.8% in P1 and 30% in P2 (RR=1; 95% CI, 0.6-1.7).Conclusions. Changes in the epidemiology and microbiological etiology of prosthetic valve endocarditis were observed over the 20-year study period. Diagnostic and therapeutic approaches also changed, but mortality remained high.