葡萄球菌感染性心内膜炎46例临床分析

Clinical analysis of Staphylococcus infective endocarditis:46 cases report

目的探讨葡萄球菌感染性心内膜炎(IE)患者的临床和病原学特征,为临床诊治提供依据。方法对北京协和医院2011年至2018年住院治疗的46例葡萄球菌IE患者进行回顾性分析。结果本组46例葡萄球菌IE,占同期诊断的425例IE总数的10.8%。发热(97.8%)是最常见的临床表现,其次是贫血(73.3%)和心脏杂音(63.0%)。并发症主要是心力衰竭(52.2%)和脏器栓塞(43.5%)。病原菌为金黄色葡萄球菌的38例(82.6%),其中甲氧西林耐药菌株12例(31.6%);病原菌为凝固酶阴性葡萄球菌的8例(17.4%),其中甲氧西林耐药菌株6例(75.0%)。住院期间死亡4例(8.7%)。与链球菌IE患者相比,葡萄球菌IE有基础慢性疾病的比例更高(P=0.008),并发感染性休克的比例更高(P<0.01);累及左心的比例较低(P<0.01),累及人工瓣膜/装置的比例较高(P<0.01),出现脓肿形成的比例较高(P=0.005);住院期间死亡/未愈的比例较高(P=0.015)。结论葡萄球菌是IE重要的致病菌,相比链球菌IE而言,葡萄球菌IE病情进展更快,合并基础慢性疾病和并发症更多,预后更差,这使得葡萄球菌IE的临床治疗更具挑战性。

Objective The purpose of this paper is to explore the clinical and etiological characteristic of patients with staphylococcus infective endocarditis(IE),to provide evidence for diagnosis and treatment.Methods This retrospective study included a cohort of 46 staphylococcus IE patients hospitalized in Peking Union Medical College Hospital from 2011 to 2018.Results The incidence of staphylococcus IE was 46 cases,accounted for 10.8%among 425 IE inpatients at the same time.Fever(97.8%)was the most common clinical presentation,followed by anemia(73.3%)and cardiac murmur(63.0%).Congestive heart failure(52.2%)and embolism(43.5%)were the most common complications.Among 46 staphylococcus strains,38 stains(82.6%)were S.aureus(percentage of methicillin-resistant was 31.6%),while 8 strains(17.4%)were S.coagulase negative(percentage of methicillin-resistant was 75.0%).Four(8.7%)died during hospitalization.Compared with streptococcus IE,staphylococcus IE was associated with higher prevalence of underlying chronic disease(P=0.008),higher prevalence of complicated septic shock(P<0.01),lower prevalence of left side IE(P<0.01)and higher prevalence of prosthetic valves/devices(P<0.01);abscess formation were more frequent in staphylococcus IE(P=0.005).Inpatients with staphylococcus IE were more likely to have higher mortality and/or non-healing rate(P=0.015).Conclusion Staphylococcus(mostly S.aureus)is an important pathogen of IE.Compared with Streptococcus IE,patients with staphylococcus IE are likely to have more severe disease,more comorbidities and complications,and a poor prognosis.Management of staphylococcus IE is a challenge to physicians.