Survey of prophylaxis and management of infective endocarditis in patients with congenital heart disease: Japanese nationwide survey.
Survey of prophylaxis and management of infective endocarditis in patients with congenital heart disease: Japanese nationwide survey.
复制标题
先天性心脏病患者感染性心内膜炎的预防和治疗调查：日本全国调查。
作者：
K. Niwa;M. Nakazawa;K. Miyatake;S. Tateno;M. Yoshinaga
先天性心脏病（CHD）儿童感染性心内膜炎（IE）的预防和管理指南尚未制定，因此本研究的目的是通过全国范围的调查来阐明日本先天性心脏病（CHD）患者感染性心内膜炎（IE）的发病率、实际预防和管理。我们向日本小儿心脏病学和心脏外科学会的成员发送了一份书面调查问卷，并从 228 个机构的 236 名心脏病专家那里获取了信息。 1997 年至 2001 年期间，有 408 名 IE 患者住院（1/173 因 CHD 入院，包括因心导管插入术或手术住院的患者）。 92% 的心脏病专家采取了预防 IE 治疗先心病的措施，通常开具口服青霉素 (73%)，较少使用头孢类药物 (18%)。 38% 的人使用杜克标准作为临床标准。仅 40% 的人进行过一次血培养。青霉素和氨基糖苷类 (38%) 经常用于治疗培养阴性 IE。用于预防和管理 IE 的抗生素剂量和持续时间存在差异。看来，CHD 中 IE 的患病率正在上升，全国范围的调查显示，CHD 患者中 IE 的实际预防和管理差异比预期更大。该结果应有助于制定未来的先心病 IE 管理指南。
Guidelines for the prevention and management of infective endocarditis (IE) in children with congenital heart disease (CHD) have not been established, so the aim of this study was to clarify the incidence, practical prevention and management of IE in patients with CHD in Japan through a nationwide survey. A written questionnaire was sent to members of the Japanese Society of Pediatric Cardiology and Cardiac Surgery and information was obtained from 236 cardiologists in 228 institutions. Four hundred and eight patients with IE were hospitalized during 1997 to 2001 (1/173 admissions with CHD including those hospitalized for cardiac catheterization or surgery). Prevention of IE for CHD was undertaken by 92% of cardiologists, usually oral penicillins (73%) and less frequently cephems (18%) were prescribed. The Duke criteria were used as clinical criteria by 38%. Blood culture was performed once only by 40%. Penicillins and aminoglycosides (38%) were frequently administered for management of culture-negative IE. There were variations in the dose and duration of antibiotics for prevention and management of IE. It appears that the prevalence of IE in CHD is rising and the nationwide survey revealed more variations in practical prevention and management of IE in patients with CHD than expected. The results should be helpful in making future guidelines for management of IE in CHD.