| Objective:To summarize the clinical characteristic, therapy and prognostic factors of infective endocarditis (IE) by analyzing clinical data, to improve the diagnosis and treatment.Methods:Clinical features of283patients with IE from January2004to December2011were analyzed retrospectively.Result:(1)65.7%of patients had underlying diseases, including rheumatic heart disease (30.7%) and congenital heart disease(18.7%).(2) Risk factors for IE such as intravenous drug addiction and interventional therapy played an important role.(3) Fever was observed in84.80%.Other manifestation such as anemia, kidney damage and embolization were also common.(4)56.6%of blood cultures were positive. Streptococcus (48.6%) and staphylococcus (33.3%) were isolated mainly. The composition of streptococcus and staphylococcus had no change with time (P>0.05), but ratio of staphylococcus increased from27.3%to37.0%within8years.(5)Vegetation was found in236patients (83.4%), including left-side (77.1%), right-side (22.5%) and both-side (0.4%). Secondary damage of valves such as perforation, tendon rupture, and dehiscence of a prosthetic valve could be seen by echocardiograph.(6)53.7%had been administrated medical treatment including antimicrobial primarily, whereas45.9%underwent combined medical and surgical treatment.(7)73%of patients were cured. The mortality was7.1%. Many patients (19.9%) decided to abandon therapy and discharged. On multivariate analysis, embolization was independently associated with mortality.(8)IDUs IE showed characteristic as follows, compared with non-IDUs:①96.8%of IDUs were male, more than non-IDUs (P<0.01). Average age was lower (29.1±5.4vs.37.5±14.8, P<0.01).83.9%of IDUs were20-35years old, more than non-IDUs (P<0.01).83.9%of IDUs had no underlying deceases before, different from IDUs (44.0%)(P<0.01).②E in IDUs was different from non-IDUs, more being complicated with communicated diseases (77.4%vs.15.1%, P<0.01).③IDUs presented fever and respiratory symptom more (100%vs.82.9%, P<0.01;67.7%vs.44.8%, P<0.05).④There was no significant difference in positive ratio of blood culture (P>0.05). S. aureus were isolated more (P<0.01).⑤Right-side vegetations and big vegetations(≥10mm)were seen more easily (P<0.01).⑥By chest X-rays pulmonary infiltration were increased (83.9%vs.27.4%, P<0.01).⑦71.0%of IDUs had been administrated medical therapy lonely, different from non-IDUs (52.0%)(P<0.05).⑧There were no significant differences in clinical cure rate, hospital mortality and abandoning therapy rate, respectively (P>0.05).Conclusion:(1) IE occurred mostly on the basis of underlying heart disease, and new risk factors such as intravenous drug use, interventional heart treatment should be paid attention to.(2) Streptococcus and staphylococcus were isolated mainly. The composition of streptococcus and staphylococcus had no change with time, but staphylococcus had trend to increase.(3) Fever was the most common symptom, with anemia, kidney damage or embolization etc.(4) Blood culture and echocardiography were important for diagnosis, positive rate of which to be further improved.(5) About2/3patients could be cured. Hospital mortality was low, for most patients gave up. Embolization was independently associated with hospital mortality.(6)IDUs IE usually onset in young men, most of whom were healthy before. All had fever, and respiratory symptoms were seen obviously. S. aureus was the main causative agent. Right-sided vegetation was observed by echocardiography. Most chest X-rays showed pulmonary infiltration. Most IDUs had been administrated medical therapy lonely, and other1/3combined surgical treatment. There was no significant difference in prognosis between IDUs and non-IDUs. |
PDF Full Text Request