| Objective In an attempt to improve the clinical diagnosis and treatment of infective endocarditis(IE),the clinical characteristics,distribution and antibiotic resistance of pathogens,diagnosis,treatment and prognosis of patients with IE who were admitted to Nanjing Hospital Affiliated to Nanjing Medical University in the latest 7 years were analyzed.Methods We retrospectively studied 135 patients with definite IE who were admitted to the hospital from March 2012 through December 2018.The demographic characteristics,clinical manifestations,complications,laboratory examinations,treatment and prognosis were analyzed.The independent risk factors associated with the increase of neurological complications of IE were determined by multivariate logistic regression analysis.Chi-square test and Fisher’s exact test were applied to test the distribution of pathogens,the antibiotic resistance of pathogens,and the hospital mortality among different groups.Results 1.Congenital heart disease(20.7%)and non-rheumatic heart disease(20.7%)were the most common heart valvular diseases of IE patients in this study,and rheumatic heart disease accounting for only 7.4%.30 patients(22.2%)had been treated with heart surgery or interventional therapy,and 17 patients(12.6%)had healthcare-associated(HA)IE.2.Neurological complications were the most common extracardiac complications of IE,mostly in left-sided valve IE.In multivariate logistic regression analysis,the two independent risk factors associated with the increase of neurological complications were Staphylococcus aureus infection(OR:4.680,P:0.046)and hypertension(OR:3.747,P:0.010).3.Streptococcus were the most common pathogens of native valvular endocarditis(NVE),late prosthetic valvular endocarditis(PVE)and community-acquired(CA)IE.Staphylococcus were the most common pathogens in early PVE and healthcare-associated(HA)IE.There was significant difference between the proportion of Streptococcus in CAIE group and that in HAIE group(56.8%vs20.0%,P=0.036).The resistance rate of Streptococcus to beta-lactams was increased from 0% in 2012 and 2015 to 11.1% in 2016 and 2018.The resistance rate of Staphylococcus to beta-lactams was increased from 80.0% in 2012 and 2015 to 90.9% in 2016 and 2018.4.108 cases(80.0%)with vegetations were found by transthoracic echocardiography(TTE),while 17 cases with multiple-valvular vegetations and 8 cases with abscesses were not detected.Positron emission tomography(PET-CT)was performed in 7 patients and 5 were positive while 2 of them were TTE negative,and 1 had some vegetations missed by TTE.5.The hospital mortality rate of the medical treatment group(medical treatment alone)was higher than that of the surgical treatment group(medical treatment in combination with surgical treatment)(20.0%vs2.7%,P=0.006).In the medical treatment group,the hospital mortality rate of the group with operation indication was higher than that of the group without operation indication(37.5%vs0.0%,P=0.046).Conclusions In this study,we found that congenital heart disease and non-rheumatic heart valvular disease were the most common heart diseases of IE.Heart surgery and interventional therapy became a new predisposing factor of IE.Neurological complications were the most common extracardiac complications of IE,especially left-sided valve IE.Staphylococcus aureus infection and hypertension were independent risk factors associated with the increase of neurological complications of IE.The sensitivity of TTE was high,but multiple-valvular vegetations and abscesses were often missed.PET-CT can be used as a supplementary diagnostic method of IE.Streptococcus were the most common pathogen of NVE,late PVE and CAIE.Staphylococcus were the most common pathogen of early PVE and HAIE.The resistance rate of Streptococcus to beta-lactams was low,and Staphylococcus was highly resistant to beta-lactams.Surgical treatment is an effective treatment for IE.Patients with operation indications are suggested being treated with surgical treatment. |
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