Clinical characteristics of 425 cases with infective endocarditis
10.3760/cma.j.cn311365-20210408-00120
- VernacularTitle:感染性心内膜炎患者425例的临床特征分析
- Author:
Xiaochun SHI
1
;
Xiaoqing LIU
Author Information
1. 中国医学科学院北京协和医学院 北京协和医院感染内科，疑难重症及罕见病国家重点实验室，北京 100730
- Keywords:
Endocarditis, bacterial;
Signs and symptoms;
Pathogens
- From:
Chinese Journal of Infectious Diseases
2022;40(1):28-32
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the clinical features of patients with infective endocarditis (IE) and to improve the awareness of this disease.Methods:A total of 425 IE patients hospitalized in Peking Union Medical College Hospital from January 2011 to December 2018 were included in this study. The clinical features, predisposing cardiac diseases, pathogens and outcomes were retrospectively analyzed. The binary logistic regression model was adopted to analyze the risk factors.Results:Among 425 IE patients, the median period from onset of disease to diagnosis was 10 weeks. Fever (423 cases, 99.5%) and cardiac murmur (372 cases, 87.5%) were the most common clinical manifestations. Congestive heart failure (219 cases, 51.5%) and embolism (158 cases, 37.2%) were the most common complications. Two hundred and fifty (58.8%) patients had predisposing cardiac diseases with congenital heart diseases (121 cases, 28.5%) as the leading cause. Vegetations were found in 410(96.5%) patients through echocardiography and surgery. Totally 343(80.7%) patients got a positive pathogen test with Streptococcus viridans accounted for 59.5%(204/343) as the major pathogen of IE.All 425 patients received antimicrobial therapy, 342(80.5%) patients received surgery, among them 332 cases (97.1%) were early surgery, and the in-hospital mortality rate was 4.5%(19/425). Logistic regression analysis showed that New York heart function assessment Ⅲ/Ⅳ (odds ratio ( OR)=3.40, 95% confidence interval ( CI) 1.30 to 11.68), cerebral embolism ( OR=4.45, 95% CI 1.50 to 13.22) and septic shock ( OR=19.41, 95% CI 3.81 to 99.02) were independent risk factors for in-hospital death(all P<0.050), while surgery was an independent protective factor against in-hospital death ( OR=0.15, 95% CI 0.05 to 0.47, P=0.001). Conclusions:There is still a significant delay in the diagnosis of IE. Physicians should be alert to IE. Multiple sets of blood cultures should be obtained before administration of antibiotics, and echocardiography should be performed in all patients with suspected IE as soon as possible. Bactericidal antimicrobial therapy and early surgery in patients with indications are critical aspects in the management of IE patients.
