Nosocomial vs. community-acquired infective endocarditis in Greece: changing epidemiological profile and mortality risk
Nosocomial vs. community-acquired infective endocarditis in Greece: changing epidemiological profile and mortality risk
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DOI：
10.1111/j.1469-0691.2007.01746.x
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发表时间：
2007-08-01
影响因子：
14.2
通讯作者：
Giamarellou, H.
中科院分区：
文献类型：
--
作者：
Giannitsioti, E.;Skiadas, I.;Giamarellou, H.
通过对雅典市区14家三级医院和6家综合医院2000-2004年期间所有符合杜克标准的感染性心内膜炎(IE)病例进行前瞻性队列研究，调查了目前希腊感染性心内膜炎(IE)的流行趋势。比较医院获得性IE(NIE)和社区获得性IE(CIE)的人口学特征、临床数据和预后。195例中NIE 42例(21.5%)，CIE 153例(78.5%)。静脉用药仅与CIE有关，而NIE组的并存(心血管疾病、糖尿病、需要血液透析的慢性肾功能衰竭和恶性肿瘤)更为常见(p<；0.05)。人工瓣膜心内膜炎在NIE组中占主导地位(p<0.006)，50%的NIE患者有血管介入治疗的病史。凝固酶阴性葡萄球菌和肠球菌在NIE患者中的发生率明显高于CIE患者(分别为26.2%和5.2%，P<0.01)和30.9%与16.3%(P<0.05)。肠球菌占IE病例总数的19.5%，是引起NIE的主要原因。金黄色葡萄球菌IE医院获得率仅为11.9%。NIE组的住院死亡率高于CIE组(39.5%比18.6%，P<0.02)。心力衰竭(纽约心脏协会分级III-IV；OR13.3，95%CI4.9-36.1，p<；0.001)和人工瓣膜心内膜炎(OR3.7，95%CI1.3-10.6，p0.01)是最重要的死亡率预测因素。
Current epidemiological trends of infective endocarditis (IE) in Greece were investigated via a prospective cohort study of all cases of IE that fulfilled the Duke criteria during 2000-2004 in 14 tertiary and six general hospitals in the metropolitan area of Athens. Demographics, clinical data and outcome were compared for nosocomial IE (NIE) and community-acquired IE (CIE). NIE accounted for 42 (21.5%) and CIE for 153 (78.5%) of 195 cases. Intravenous drug use was associated exclusively with CIE, while co-morbidities (cardiovascular disease, diabetes mellitus, chronic renal failure requiring haemodialysis and malignancies) were more frequent in the NIE group (p < 0.05). Prosthetic valve endocarditis (PVE) predominated in the NIE group (p 0.006), and > 50% of NIE cases had a history of vascular intervention. Coagulase-negative staphylococci and enterococci were more frequent in cases of NIE than in cases of CIE (26.2% vs. 5.2%, p < 0.01, and 30.9% vs. 16.3%, p 0.05, respectively). Enterococci accounted for 19.5% of total IE cases and were the leading cause of NIE. Staphylococcus aureus IE was hospital-acquired in only 11.9% of cases. In-hospital mortality was higher for NIE than for CIE (39.5% vs. 18.6%, p 0.02). Cardiac failure (New York Heart Association grade III-IV; OR 13.3, 95% CI 4.9-36.1, p < 0.001) and prosthetic valve endocarditis (OR 3.7, 95% CI 1.3-10.6, p 0.01) were the most important predictors of mortality.