The Infectious Tricuspid Endocarditis in ICU： Clinical Features, Management and Outcome

Objectives： Infectious tricuspid endocarditis is known to simply require antibiotherapy and to have good prognosis in most cases. Few studies focused on severe episodes managed in ICU. We aimed to describe clinical and microbiological features, and fmal outcome of infectious tricuspid endocarditis managed in ICU. Methods： From 1 January 2009 to 31 August 2017, all patients hospitalized in intensive care unit with infectious tricuspid endocarditis were enrolled. Key findings： We collected 15 episodes of infectious tricuspid endocarditis. Median age was of 39 years. Risk factors were： intravenous drug users （n = 10）, pace maker （n = 1）, vascular device （n = 2）, none （n = 2）. Median SAPS II, APACHE II and SOFA on admission were 21, 10 and 2 respectively. Organ failures on admission were： acute respiratory failure （n = 10）, sepsis （n = 7）, coma （n = 1） and acute kidney injury （n = 8）. The most frequent causative pathogen was Staphylococcus Aureus. Antibiotherapy failure happened in 10 patients from whom 8 underwent cardiac surgery （53.3%）. Most frequent complications were acute kidney injury （n = 14） and withdrawal syndrom. Infectious tricuspid endocarditis relapse on bioprosthesis occurred within 2 intravenous drug users after hospital discharge. Overall in-hospital mortality was 40%. Conclusions： Infectious tricuspid endocarditis in ICU is fitted with poor prognosis and high need to cardiac surgery. Special care should be provided to intravenous drug users to prevent relapse.

右心感染性心内膜炎15例临床分析

目的回顾性分析右心感染性心内膜炎(RSIE)的临床特征,为其早期诊断和及时治疗提供临床参考。方法对天津医科大学总医院2004年1月—2010年12月住院治疗的15例右心感染性心内膜炎患者的临床资料进行回顾性分析。结果有基础心脏病者9例,其中先天性心脏病7例(46.7%),室间隔缺损最为常见;静脉药瘾者5例(33.3%);不洁静脉输液史2例;拔牙史1例。临床主要表现为发热(100%),心脏杂音改变(12例,80.0%),肺炎或肺脓肿、肺栓塞(13例,86.7%)。15例中血培养阳性11例(73.3%),其中金葡菌(6例,54.5%)为最常见病原菌(其中耐甲氧西林金葡菌1例);其次为链球菌属(4例,36.3%);铜绿假单胞菌1例考虑为医院获得性感染。11例(73.3%)好转或治愈,其中8例为单纯抗感染治疗,均为多种抗生素联合治疗;3例接受外科手术治愈。死亡1例,死于重症铜绿假单胞菌感染导致多脏器衰竭。结论右心感染性心内膜炎主要发生于先天性心脏病及静脉药瘾者,临床表现以高热、肺部炎症及栓塞症状突出。金葡菌为最常见病原菌。医院获得性感染应引起重视。经有效抗生素治疗预后良好。

1例感染性心内膜炎患者的抗菌药物治疗

1例18岁女性患者,因发热50余天入院。患者自幼发现动脉导管未闭,未行手术治疗。入院前50余天出现发热,就诊于多家医院,诊为"感染性心内膜炎",多次血培养中3次提示耐万古霉素金黄色葡萄球菌,1次为万古霉素敏感金黄色葡萄球菌。患者先后接受头孢曲松、青霉素、去甲万古霉素等多种抗菌药物治疗,效果不佳。就诊我院后,心脏超声发现肺动脉外侧壁导管开口附近赘生物,进一步明确心内膜炎诊断,给予大剂量头孢唑啉治疗,感染症状逐步消退,后接受手术治疗,纠正先心病和清除赘生物,术后康复良好。抗感染治疗持续至术后6周停药,随访未发现感染复发症状。

感染性心内膜炎患者病原菌分布、耐药性及其变化趋势分析

目的探讨感染性心内膜炎病原菌分布、耐药性以及变化趋势,为临床合理用药提供依据。方法选取2013年5月至2014年12月进入青海省心脑血管病专科医院治疗的83例感染性心内膜炎患者作为研究对象,对患者进行血培养并鉴定病菌种类,提取菌株通过药敏试验对病菌耐药性分析。结果 83例患者共培养出158株病原菌,其中革兰氏阳性菌株125株,占总菌株数79.11%;革兰氏阴性菌株27株,占总菌株数17.09%;真菌菌株6株,占3.80%;革兰氏阳性菌株数量均高于革兰氏阴性菌株和真菌菌株,差异有统计学意义(P<0.05)。革兰氏阳性菌中,金黄色葡萄球菌对青霉素耐药率较高,为89.19%,对万古霉素、利奈唑胺较敏感,耐药率为0.00%、2.70%;链球菌属对红霉素、克林霉素、四环素耐药率为53.99%、49.46%、78.36%,对万古霉素耐药率均为0.00%;粪肠球菌对红霉素、头孢唑林、四环素耐药率为60.00%、40.00%、80.00%,对青霉素、万古霉素、利奈唑胺、阿特维斯耐药率均为0.00%。革兰氏阴性菌中铜绿假单胞菌对青霉素、头孢唑林耐药率为84.62%、84.62%;对氨曲南、美罗培南、左氧氟沙星耐药率均为0.00%。产气肠杆菌对呋喃妥因、氨曲南耐药率为75.51%、63.27%,对庆大霉素、头孢曲松、头孢哌酮耐药率为0.00%。大肠埃希菌对青霉素、头孢唑林、头孢曲松、头孢哌酮耐药率为85.00%、100.00%、85.00%、85.00%,对美罗培南、妥布霉素、左氧氟沙星耐药率均为0.00%。A组42例患者中共检测病原菌88株,B组41例患者共检出病原菌70株;A组病原菌检出率明显高于B组,差异有统计学意义(P<0.05)。金黄色葡萄球菌和酿脓链球菌仍是感染性心内膜炎主要致病菌,其中A组酿脓链球菌、产气肠杆菌、大肠埃希菌显著高于B组,金黄色葡萄球菌显著低于B组,差异有统计学意义(P<0.05)。结论感染性心内膜炎病原菌多为革兰氏阳性菌,应根据患者致病菌耐药性选择合适的抗菌药物进行治疗,以促进患者早日康复。

Intracranial hemorrhagic embolus

A febrile and unconscious man was sent to our emergency department. On physical examinations, some dark red ecchymosis/discoloration over the trunk and track mark in the left-sided groin region were seen. Brain CT scan showed septic emboli complicated with hemorrhage. Chest X-ray revealed pulmonary emboli. Aortic valve vegetation was found by echocardiography. Although aggressive treatment and resuscitation were taken, he died of methicillin-sensitiveStaphylococcus aureus sepsis and multiple organ failure. Intravenous drug users are susceptible to right-sided infective endocarditis. In our case, left-sided infective endocarditis with lung and brain embolism resulting in fatality was relatively uncommon. Review of literature was also made for this article.

静脉毒瘾者金黄色葡萄球菌性感染性右心内膜炎(附2例报告及文献复习)

本文在国内首次报道２例静脉毒瘾者金黄色葡萄球菌性感染性右心内膜炎（ＳＩＲＥＤ），其临床特点：①常合并有肝炎病毒感染；②确诊有赖于心脏超声检查发现三尖瓣赘生物、细菌的毒血症状及血培养的结果；③治疗应根据药敏结果选择２至３种敏感的抗生素联用，其剂量应比常规量大２至３倍，疗程６至８周或更长；④有效治疗后。

经静脉应用毒品致右心感染性心内膜炎肺损害

目的 提高对右心感染性心内膜炎肺损害的认识。方法 通过胸片、胸部B超、血气分析、痰培养等检查手段对 1994～ 2 0 0 0年住院的 2 8例静脉应用毒品致右心感染性心内膜炎肺损害的病例进行回顾性分析。结果 肺损害占 10 0 % (2 8/ 2 8) ,咳嗽占 10 0 % (2 8/ 2 8) ,咳痰占 71% (2 0 / 2 8) ,气促占 6 4% (18/ 2 8) ,胸痛占 5 7% (16 / 2 8) ,咯血占 36 % (10 / 2 8) ,肺部音占 71% (2 0 / 2 8)。胸片 :浸润性改变占 82 % (2 3/ 2 8) ,多发性囊状影占 2 1% (6 / 2 8) ,肺栓塞占 2 1% (6 / 2 8) ,胸腔积液占 2 1% (6 / 2 8)。B超胸腔积液占 2 1% (6 / 2 8)。Ⅰ型呼吸衰竭占 14% (4 / 2 8)。痰培养阳性率 5 4% (15 / 2 8)。选用 2～ 3种抗生素治疗 4～ 6周 ,有效占 82 % (2 3/ 2 8) ,无效而手术占 18% (5 / 2 8) ,其中手术的 2例死亡 ,病死率7% (2 / 2 8)。结论 右心感染性心内膜炎肺损害在应用毒品者十分常见 ,应引起重视 。