Prosthetic Valve Endocarditis: Analysis of 38 Cases
Prosthetic Valve Endocarditis: Analysis of 38 Cases
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人工瓣膜心内膜炎38例分析
DOI：
10.1161/01.cir.48.2.365
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发表时间：
1973
期刊：
影响因子：
37.8
通讯作者：
M. Swartz
中科院分区：
文献类型：
--
作者：
W. Dismukes;A. Karchmer;M. Buckley;W. Austen;M. Swartz
38例人工瓣膜心内膜炎中，早期（植入后60天内发病）19例，晚期（植入后60天内发病）19例。9例晚期病例在术后12 ~ 53个月发病。晚期病例的来源或诱发因素包括牙科疾病或操作;泌尿生殖道手术;皮肤、泌尿或伤口感染。相反，大多数早期病例继发于手术并发症。链球菌是引起晚期心内膜炎最常见的微生物，而葡萄球菌在早期病例中最常见。早期发病存活的6例患者中有4例仅接受抗生素治疗，其他患者接受抗生素加再次手术治疗。相比之下，11例存活的晚期病例中有7例仅用抗生素治疗，其他4例用抗生素加再次手术治疗。晚期组较低的死亡率（42%对68%）可能反映了较低的致病性感染微生物和宿主较好的临床状况。无论人工瓣膜心内膜炎是早期还是晚期发生，在选定的情况下，加强和延长适当的抗生素治疗以及积极的外科手术再次干预似乎是治愈的必要条件。任何有人工瓣膜的患者，如果接受任何可能产生菌血症的手术，都应该接受抗生素预防，以防止晚期心内膜炎。
In 38 cases of prosthetic valve endocarditis, 19 were early cases (onset ≦ 60 days after insertion of prosthesis) and 19, late cases (onset ≧ 60 days). Nine late cases had onsets 12 to 53 months after surgery. The sources or predisposing factors in late cases included dental disease or manipulation; genitourinary tract procedures; and skin, urinary, or wound infections. In contrast, most early cases were secondary to complications of operation. Streptococci were the most common organisms causing late endocarditis, whereas staphylococci were most common among early cases. Four of the six patients who survived early onset were treated with antibiotics alone; the others, with antibiotics plus reoperation. In contrast, seven of the 11 late cases that survived were treated with antibiotics alone; the other four, with antibiotics plus reoperation. The lower mortality (42% vs 68%) in the late group probably reflects the less virulent infecting organisms and the better clinical condition of the hosts. Regardless of whether prosthetic valve endocarditis occurs early or late, intensive and prolonged administration of appropriate antibiotics together with aggressive surgical reintervention in selected situations appears necessary for cure. Any patient who has a prosthetic valve and undergoes any procedure likely to produce bacteremia should receive antibiotic prophylaxis in an attempt to prevent late endocarditis.