植被大小与部分口服抗生素内心炎治疗试验结果之间的关联
Rasmus Carter-Storch1, Mia Marie Pries-Heje2, Jonas A Povlsen3
1Department of Cardiology, Odense University Hospital, Odense, Denmark.
The American journal of cardiology
|May 4, 2024
概括
逐步降低口服抗生素治疗对于左侧传染性内心炎是安全有效的,即使有大量的植被或手术后. 与静脉注射治疗相比,这种方法提供了一个非劣质的长期结果.
科学领域:
- 心脏病学 心脏病学
- 传染性疾病 传染性疾病
- 药理学 药理学是指药理学的学科.
背景情况:
- 左侧传染性内心炎 (IE) 传统上需要长时间的静脉注射 (IV) 抗生素.
- 逐步降低口服抗生素治疗越来越多地被考虑,但其在复杂的IE病例中的有效性仍在研究中.
研究的目的:
- 为了评估逐步降低口服抗生素治疗与继续IV治疗的非劣势,在患有大植被 (≥10毫米) 或在口服治疗之前接受手术的患者中.
- 评估口服渐进治疗在特定高风险IE小组中的安全性和长期结果.
主要方法:
- 从部分口服抗生素内心炎治疗 (POET) 研究的数据分析,不包括患有大动脉根的患者.
- 多变量考克斯回归模型被用来分析大植被,心脏手术,逐步降低口服治疗和复合主终点之间的关联.
- 主要终点包括全因死亡率,无计划的心脏手术,栓塞事件或阳性血液培养的复发.
主要成果:
- 总共有368名患者被纳入;124人有大量的植被,更有可能接受手术 (65%对20%).
- 大型植被与主要终点没有显著的关联 (HR 0.74,95% CI 0.47-1.18,p=0.21).
- 逐步下降的口服疗法在所有子组中都显示出与持续的静脉注射疗法相比的非劣势,包括那些有大量植被和那些早期接受心脏手术的子组.
结论:
- 逐步降低口服抗生素治疗是一种安全有效的治疗选择,用于左侧感染性内心炎.
- 这种方法与持续的静脉注射疗法相比并非劣,即使是在具有大量植被或经过早期心脏手术的患者中也是如此.
- 在这些复杂的IE患者群体中,可以安全地实施口服降级疗法.
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