感染性心臓内膜炎で入院した患者の発生率,微生物学,結果
Anoop S V Shah1,2, David A McAllister3, Peter Gallacher1
1British Heart Foundation Centre for Cardiovascular Science (A.S.V.S., P.G., F.A., J.H., K.K.L., R.B., A.A., N.L.M., D.E.N.), University of Edinburgh, United Kingdom.
Circulation
|May 16, 2020
まとめ
感染性心内炎の発生率は安定しているが,高齢者では倍増している. ガイドラインの変更にもかかわらず,Staphylococcus aureusとEnterococcus bacteremiaはより高い死亡率に関連しています.
科学分野:
- 心臓病科
- 感染症
- 公衆衛生
背景:
- 感染症性心内炎 (IE) は,治療の進歩にもかかわらず,依然として重大な死亡率と発症リスクをもたらしています.
- IEの発生率,微生物学,および結果の時間的な傾向を理解することは,治療戦略を洗練するために不可欠です.
研究 の 目的:
- スコットランドにおける感染性心内炎の発生率,微生物学,結果の時間的変化を分析する.
- 更新された抗生物質予防ガイドラインがIE発生率に与える影響を評価する.
主な方法:
- スコットランド全域で個別レベルのリンク研究で,1990年から2014年までIEで入院した患者が特定されました.
- 傾向分析のために,国内微生物学,処方,死亡データセットとリンクされた.
- 2008年ガイドラインの更新前と後の発生率の変化を評価した.
主要な成果:
- 原始的なIE入院率は当初 (1990年−1995年) 増加し,その後安定し,2008年ガイドライン更新以降は大きな変化はなかった.
- 80歳以上の患者の罹患率は1990年から2014年の間に2倍になりました.
- 研究期間中,年齢と併発性により調整された症例死亡率は男性と女性の両方で減少した.
- 血液培養で確認された最も一般的な病原菌は,スタフィロコーカスとストリープトコックスの種でした (2008年以降).
- Staphylococcus aureusとEnterococcus bacteremiaは1年以内に死亡率が著しく高かった.
結論:
- 更新された抗生物質予防ガイドラインに従って,原始的な感染症性内心炎の発生率は変化しなかった.
- 高齢者 (80歳以上) において,IEの発生率が顕著に増加した.
- ステロコッカス・オーレウスとエンテロコッカス感染は,IE患者の死亡リスクが高い.
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