Coagulase-negative staphylococcal prosthetic valve endocarditis-a contemporary update based on the International Collaboration on Endocarditis: prospective cohort study
Coagulase-negative staphylococcal prosthetic valve endocarditis-a contemporary update based on the International Collaboration on Endocarditis: prospective cohort study
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DOI：
10.1136/hrt.2008.152975
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发表时间：
2009-04-01
期刊：
影响因子：
5.7
通讯作者：
Fowler, V. G., Jr.
中科院分区：
文献类型：
--
作者：
Chu, V. H.;Miro, J. M.;Fowler, V. G., Jr.
目的：探讨凝血酶阴性葡萄球菌（con）人工瓣膜心内膜炎（PVE）的临床特点。设计：对感染性心内膜炎患者多国队列前瞻性收集数据的观察性研究。将con PVE患者与金黄色葡萄球菌和翠绿链球菌（VGS） PVE患者进行比较。背景：心内膜炎国际合作前瞻性队列研究（ICE-PCS）是一项来自28个国家61个中心的感染性心内膜炎患者的当代队列研究。患者：纳入2000年6月至2005年8月ICE-PCS中明确PVE且无注射吸毒史的成年患者。干预措施:没有。主要观察指标：心力衰竭、心内脓肿、死亡。结果：537例明确的非注射吸毒相关性PVE中，有16%（86例）发生了con。近一半（n = 33/ 69,48%）的con - PVE患者出现在瓣膜植入术的60天至365天之间。con PVE患者心内脓肿发生率（38%）明显高于金黄色葡萄球菌（23%,p = 0.03）或VGS (20%, p = 0.05) PVE患者。脓疡率在早期（50%）和中期（52%）特别高。con PVE的住院死亡率为24%，金黄色葡萄球菌PVE为36% (p = 0.09)， VGS PVE为9.1% （p = 0.08）。68%的con菌株对甲氧西林耐药。结论：近一半的con - PVE病例发生在人工瓣膜植入术60天至365天之间。缺点：PVE与甲氧西林耐药率高和瓣膜并发症显著相关。
Objective: To describe the contemporary features of coagulase-negative staphylococcal (CoNS) prosthetic valve endocarditis (PVE).Design: Observational study of prospectively collected data from a multinational cohort of patients with infective endocarditis. Patients with CoNS PVE were compared to patients with Staphylococcus aureus and viridans streptococcal (VGS) PVE.Setting: The International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS) is a contemporary cohort of patients with infective endocarditis from 61 centres in 28 countries.Patients: Adult patients in the ICE-PCS with definite PVE and no history of injecting drug use from June 2000 to August 2005 were included.Interventions: None.Main outcome measures: Heart failure, intracardiac abscess, death.Results: CoNS caused 16% (n = 86) of 537 cases of definite non-injecting drug use-associated PVE. Nearly one-half (n = 33/69, 48%) of patients with CoNS PVE presented between 60 days and 365 days of valve implantation. The rate of intracardiac abscess was significantly higher in patients with CoNS PVE (38%) than in patients with either S aureus (23%, p = 0.03) or VGS (20%, p = 0.05) PVE. The rate of abscess was particularly high in early (50%) and intermediate (52%) CoNS PVE. Inhospital mortality was 24% for CoNS PVE, 36% for S aureus PVE (p = 0.09) and 9.1% for VGS PVE (p = 0.08). Meticillin resistance was present in 68% of CoNS strains.Conclusions: Nearly one-half of CoNS PVE cases occur between 60 days and 365 days of prosthetic valve implantation. CoNS PVE is associated with a high rate of meticillin resistance and significant valvular complications.