Effect of penicillin resistance on presentation and outcome of nonenterococcal streptococcal infective endocarditis
Effect of penicillin resistance on presentation and outcome of nonenterococcal streptococcal infective endocarditis
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DOI：
10.1159/000091821
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发表时间：
2006-01-01
期刊：
影响因子：
1.9
通讯作者：
Lin, Fang-Yue
中科院分区：
文献类型：
--
作者：
Hsu, Ron-Bin;Lin, Fang-Yue
背景与目的：感染性心内膜炎多由非肠球菌性链球菌引起。对青霉素耐药菌株的出现日益在世界范围内得到承认。本研究旨在评估青霉素耐药性对链球菌性包心炎的表现和预后的影响。方法：在某三级医院进行回顾性研究。结果：1996年8月至2004年12月期间，感染非肠球菌链球菌性心包炎且已知对青霉素最低抑制浓度（mic）的患者纳入本研究。共发现62例：48例（77%）链球菌性包房炎是由翠绿链球菌引起的。最常见的菌种群分别为：炎链球菌12例（19%）、口腔链球菌9例（15%）、血链球菌7例（11%）和变形链球菌7例（11%）。男性36例，女性26例，中位年龄46岁（范围：1-85岁）。22例（35%）患者发生外周栓塞，10例（16%）患者在医院死亡。62例患者中28例（45%）感染的链球菌对青霉素的mic浓度为0.1125 μ g/ml。mic链球菌>= 0.1125 μ g/ml感染青霉素与全部位栓塞发生率较低相关，但与较高的死亡率或手术频率增加无关。结论：心内膜链球菌高度耐青霉素现象日益普遍，万古霉素药物治疗效果良好。青霉素耐药与栓塞风险降低有关，但与较高的死亡率无关。版权所有(c) 2006 S. Karger AG，巴塞尔
Background and Aims: Most cases of infective endocarditis are caused by nonenterococcal streptococci. The emergence of strains resistant to penicillin is increasingly recognized worldwide. This study sought to assess the effect of penicillin resistance on presentation and outcome of streptococcal enclocarditis. Methods: A retrospective study was conducted in a single tertiary care hospital. Results: Between August 1996 and December 2004, patients infected with nonenterococcal streptococcal enclocarditis and known minimal inhibitory concentrations (MICs) to penicillin were included in this study. A total of 62 cases were identified: 48 (77%) cases of the streptococcal enclocarditis were caused by viridans streptococci. The most common species groups identified were Streptococcus mitis in 12 (19%) cases, Streptococcus oralis in 9 (15%) cases, Streptococcus sanguis in 7 (11%) cases and Streptococcus mutans in 7 (11%) cases. There were 36 male and 26 female patients with a median age of 46 years (range: 1-85). Twenty-two patients (35%) had peripheral embolization and 10 patients (16%) died in hospital. Twenty-eight (45%) of the 62 patients were infected with streptococcal strains of MICs >= 0.1125 mu g/ml to penicillin. Infection with streptococcal strains of MICs >= 0.1125 mu g/ml to penicillin was associated with a lower incidence of all-site embolization, but was not associated with higher mortality or increased frequency of surgery. Conclusions: High-level penicillin resistance of the streptococci responsible for endocarditus was increasingly common and medical therapy with vancomycin had a good response. Penicillin resistance was associated with a decreased risk of embolization, but was not associated with higher mortality. Copyright (c) 2006 S. Karger AG, Basel