患有由凝血酶负型葡萄球菌引起的细菌病的患者内心炎的风险;多中心回顾性队列
Virgile Zimmermann1, Nicolas Fourré1, Bruno Ledergerber2
1Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
European journal of internal medicine
|December 28, 2025
概括
传染性内心炎 (IE) 是凝聚性阴性葡萄球菌 (CoNS) 细菌病的严重并发症. 关键预测因素包括持续的细菌病和假肢材料,新的标准显示敏感性提高,但特异性较低.
科学领域:
- 心脏病学 心脏病学
- 传染性疾病 传染性疾病
- 临床微生物学 临床微生物学
背景情况:
- 传染性内心炎 (IE) 是凝聚酶负型葡萄球菌 (CoNS) 细菌病的显著并发症.
- 在患有CoNS细菌病的患者中,早期发现IE对于及时管理和改善结果至关重要.
研究的目的:
- 在患有CONS细菌病的患者中确定IE的预测因子.
- 为了比较各种版本的杜克标准用于IE检测的诊断性能.
主要方法:
- 来自两家瑞士大学医院 (从2015年1月至2024年6月) 的CoNS细菌病的成年患者的回顾性分析.
- 使用2015年欧洲心脏病学会 (ESC),2023年ESC和2023年国际心血管传染病学会 (ISCVID) 杜克标准对IE事件的分类.
- 由内心炎团队或专家临床医生确认的IE诊断.
主要成果:
- 凝聚性阴性葡萄球菌 (CoNS) 细菌病发生在466次;IE被诊断为23% (106次).
- 预测IE的预测因素包括非鼻腔性获得,心内假肢材料,败血症,斯塔菲洛科克斯lugdunensis细菌病,持续性细菌病 (≥48小时) 和栓塞事件.
- 与2015年杜克-ESC (21%的敏感性,98%的特异性) 和2023年杜克-ESC (25%的敏感性,96%的特异性) 标准相比,2023年的杜克-ISCVID标准显示出更高的灵敏度 (76%),但较低的特异性 (61%).
结论:
- 在CoNS细菌性病例中,应强烈怀疑IE存在持续性细菌性病例,假体心内物质,非鼻腔性发作,S. lugdunensis或栓塞并发症.
- 2023年ISCVID标准提高了IE检测的灵敏度,但由于特异性较低,需要进一步改进.
- 优化诊断算法对于准确的IE诊断在CoNS细菌病患者中至关重要.
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