The Clinical Features And Prognosis Of Patients With Infective Endocarditis Were Retrospectively Analyzed

Objective: The clinical and etiological characteristics of the patients with infective endocarditis(IE)and the changing trend of the resistance of pathogenic bacteria were summarized and analyzed.The aim was to deepen the understanding of the disease and provide reference for clinical diagnosis and treatment.Methods:By retrospectively analyzing the case data of 174 diagnosed IE patients admitted to Yantai Yuhuangding Hospital affiliated to Qingdao University for 10 consecutive years from January 2008 to December 2017,including demographic data,basic heart history,auxiliary examination,prognostic risk factors,pathogenic bacteria and drug resistance,etc.According to the time of visit of IE patients,the case data were divided into two subgroups(2008-2012 and 2013-2017),and the differences in clinical characteristics,echocardiography,etiological distribution,drug resistance analysis and treatment outcomes between the two groups were compared.According to the different sites of IE,the case data were divided into three subgroups: NVE,early PVE and late PVE,and the etiological differences among the three groups were compared.SPSS 22.0statistical software was used in this study.Results:1.Clinical features: 174 IE patients were included in the study,including 113 males(64.9%)with a male to female ratio of 1.9:1 and an average age of(52.1 ± 17.2)years.Ninty-five(54.6%)IE patients had basic heart disease,and the patients with congenital heart disease accounted for the largest proportion(13.8%),followed by cardiac surgery and interventional therapy(12.1%)in 21 cases,rheumatic heart disease(10.3%)in 18 cases.Fever(76.4%)was the most common clinical symptom in IE patients,and the main complications were cardiac insufficiency(42.0%)and embolism(17.2%),among which 14 cases were cerebral infarction,accounting for 46.7%(14/30)of all embolism events.2.Eocardiography: 141 cases(77.6%)showed valvular excellations,mainly involving the left cardiac system(87.9%),with multiple involvement of the aortic valve(46.1%)and mitral valve(31.9%).3.The distribution of pathogenic bacteria: blood culture positive 101 cases(58.0%),the majority of Gram-positive bacteria 100 cases(99.01%),Streptococcus accounted for65.35%,Staphylococcus accounted for 20.79%.Enterococci accounted for 10.89% and 2cases of Gram-positive bacilli(1.98%).One case of gram-negative bacteria was Brucella,accounting for 0.99%.At the same time,Streptococcus and Enterobulus strains were cultured in 1 case(1%).4.Drug resistance analysis: The drug resistance rates of Streptococcus isolated from positive blood culture specimens to penicillin and cefotaxime were low(both 6.98%);The drug resistance rates of Staphylococcus aureus and other coagulase-negative Staphylococcus were 22.2% and 85.7%,respectively.The resistance rates of Enterococcus to penicillin,ampicillin and gentamicin were 33.3%,11.1% and 22.2%,respectively.No resistance was found to linezolid,vancomycin,teicolanin and tegacycline in the above pathogens.5.Treatment and outcome: 120 cases(69%)were treated with medical anti-infective treatment alone,and 54 cases(31.0%)were treated with surgery combined with medical anti-infective treatment.During the hospitalization,10 cases(5.7%)of IE patients died due to primary disease and complications.6.Death prognosis analysis: Univariate results showed that diabetes mellitus(P=0.001),renal insufficiency(P=0.029),heart failure(P=0.022),leukocytosis(P=0.006),and surgical treatment(P<0.001)were associated with prognosis in IE patients.Multivariate Logistic regression analysis showed leukocytosis(P=0.017,OR=0.379),cardiac insufficiency(P=0.023,OR=0.392),early surgical treatment(P=0.001,OR=12.08)and diabetes(P=0.029,OR=0.349)were independent factors affecting the prognosis of IE.7.Comparative analysis between subgroups:1)In terms of clinical manifestations and complications,there were 63 patients(91.3%)with fever in the 2008-2012 group,and 70 patients(66.7%)with fever in the2013-2017 group.The number of cases with fever as the first clinical symptom showed a decreasing trend between the two groups(P<0.01).The complication of embolism showed an increasing trend(10.1% vs 21.9%,P<0.05),among which the increase of cerebral embolism was the most significant(14% vs 12.4%,P<0.01).2)In the distribution of etiology,the positive rate showed a decreasing trend,and the proportion of streptococcus decreased,the difference was statistically significant(P <0.05).47 cases(68.1%)were positive in the blood culture of the 2008-2012 group,including 34 cases(49.3%)of streptococcus,while 54 cases(51.4%)were positive in the blood culture of the 2013-2017 group.Streptococcus accounted for 32 cases(30.5%).3)The early pathogenic bacteria of PVE were mainly coagulase-negative staphylococcus(3 cases,60%),the late pathogenic bacteria of PVE were mainly streptococcus(3 cases,50%),and the main pathogenic bacteria of NVE were streptococcus(63 cases,73.8%).Coagulase-negative Staphylococcus and Streptococcus were different among the three subgroups(P < 0.05).Conclusion:In recent years,the number of IE in this area is increasing,mainly male,combined with congenital heart disease,heart surgery and interventional therapy and other basic heart disease is more than before.Symptoms with fever,heart valve murmurs and other common,specificity is not strong.Recently,the number of IE patients with fever as the first clinical manifestation was significantly reduced.Most of the complications were cardiac insufficiency and embolism events,and the complications such as embolism events and renal insufficiency showed an increasing trend.Echocardiography plays an important role in the diagnosis of IE.Heart valve damage mostly involves the left cardiac system.The positive rate of blood culture was only 58%,and the rate of staphylococcus aureus infection increased.Streptococcus is still the main pathogenic bacteria of IE,especially grass green streptococcus and hemococcus.Diabetes mellitus,leukocytosis and cardiac insufficiency are independent risk factors affecting the prognosis of IE,which deserve the attention of clinicians.Meanwhile,it is found that early surgery combined with standardized anti-infection therapy can effectively improve the prognosis of the disease.