菌病和传染性内心炎 - - 我们错过了什么?
Clemency Nye1, Alice Maxwell1, Harriet Hughes1
1Public Health Wales, University Hospital of Wales, Heath Park, Cardiff, CF14 XW.
Clinical infection in practice
|February 26, 2024
概括
感染性内心炎 (IE) 可能被低诊断. 许多患有E. faecalis bacteremia的患者没有接受心声回声图,这表明错过了IE病例和改善管理的潜力.
科学领域:
- 传染性疾病 传染性疾病
- 心脏病学 心脏病学
- 微生物学 微生物学
背景情况:
- 菌 (Enterococcus faecalis) 是感染性内心炎 (IE) 的重要原因之一.
- 以前的研究表明,在E. faecalis细菌病例中,显著的百分比进展到IE.
- 目前的诊断实践和E. faecalis bacteremia的IE管理需要评估.
研究的目的:
- 在特定的健康委员会内评估患有E. faecalis bacteremia的患者的IE诊断率.
- 识别潜在的IE诊断不足和改善管理策略的机会.
- 根据已确定的IE流行率来评估当前的做法.
主要方法:
- 对成年患者的E. faecalis阳性血液培养的回顾性审查 (2017年10月 - 2022年3月).
- 对患者人口统计,临床特征和结果的分析,包括治疗失败的6个月随访.
- 评估心声回声图的利用率和与IE风险因素的相关性.
主要成果:
- 在E. faecalis菌病患者中诊断的IE率为7.1% (13.0%不包括多微生物培养).
- 与IE相关的因素包括社区收购,心脏/免疫风险因素,单微生物和多重阳性血液培养.
- 很大一部分 (62.1%) 患者在入院期间没有接受心声回声扫描.
结论:
- 这个队列中较低的IE率可能与较高的CVC相关感染患病率有关.
- 对IE的低诊断可能是由于心声回声扫描率较低和基于风险因素的不一致应用.
- 尽管潜在的诊断不足,但IE和非IE组的一年生存率没有差异;教育干预和多学科会议已经实施.
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