2 CASES OF ENDOCARDITIS DUE TO LACTOBACILLUS SPECIES - ANTIMICROBIAL SUSCEPTIBILITY, REVIEW, AND DISCUSSION OF THERAPY
2 CASES OF ENDOCARDITIS DUE TO LACTOBACILLUS SPECIES - ANTIMICROBIAL SUSCEPTIBILITY, REVIEW, AND DISCUSSION OF THERAPY
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DOI：
10.1093/clinids/15.2.250
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发表时间：
1992-08-01
影响因子：
11.8
通讯作者：
DODGE, RA
中科院分区：
文献类型：
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作者：
GRIFFITHS, JK;DALY, JS;DODGE, RA
尽管进行了抗菌治疗，由乳酸杆菌引起的心内膜炎仍可能导致死亡或感染复发。我们报告了两例自体二叶主动脉瓣患者的心内膜炎，这些患者存活而未复发，并回顾了文献中报道的其他39例病例。只有15个先前报告的病例中的患者仅通过药物治疗治愈。我们的一名患者感染了嗜酸乳杆菌，仅通过药物治疗就治愈了，另一名患者感染了干酪乳杆菌鼠李糖亚种，需要手术置换主动脉瓣。L.嗜酸乳杆菌耐受，L.酪蛋白鼠李糖亚种对许多测试的抗生素具有抗性。时间杀菌试验表明，青霉素或达托霉素与庆大霉素联合用药具有协同作用。青霉素和氨基糖苷类药物的协同治疗在临床上是有效的，并且似乎提供了基于微生物学数据的最佳药物治疗。
Endocarditis caused by lactobacilli may lead to death or to relapse of infection, despite antimicrobial treatment. We report two cases of lactobacillus endocarditis in individuals with native bicuspid aortic valves who survived without relapse and review the 39 other cases reported in the literature. In only 15 previously reported cases have patients been cured with medical therapy alone. One of our patients, who was infected with Lactobacillus acidophilus, was cured by medical therapy alone, and our other patient, who was infected with Lactobacillus casei subspecies rhamnosus, required surgical replacement of his aortic valve. L. acidophilus was tolerant and L. casei subspecies rhamnosus was resistant to many antibiotics tested. Combinations of penicillin or daptomycin and gentamicin were synergistic by time-kill assay. Synergistic therapy with a penicillin and an aminoglycoside was effective clinically and appears to provide optimal medical treatment on the basis of microbiological data.