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JAMA:15年间加利福尼亚州和纽约州感染性心内膜炎的变化趋势!

2017-04-30 MedSci MedSci原创

感染性心内膜炎的预防和治疗指南在过去的十年中发生了重大变化。在美国,很少有当代流行病学和心内膜炎的结果的相关研究。近期,一项发表在权威杂志JAMA上的研究量化了美国感染性心内膜炎的发病率和病因的趋势。此项研究为1998年1月1日至2013年12月31日期间,加州和纽约州数据库中确定的第一次心内膜炎住院患者的回顾性人群流行病学研究。此项研究主要分析了标准化的心内膜炎发病率和患者特征以及疾病病因学的趋

感染性心内膜炎的预防和治疗指南在过去的十年中发生了重大变化。在美国,很少有当代流行病学和心内膜炎的结果的相关研究。


近期,一项发表在权威杂志JAMA上的研究量化了美国感染性心内膜炎的发病率和病因的趋势。

此项研究为1998年1月1日至2013年12月31日期间,加州和纽约州数据库中确定的第一次心内膜炎住院患者的回顾性人群流行病学研究。

此项研究主要分析了标准化的心内膜炎发病率和患者特征以及疾病病因学的趋势。

此项研究显示:在75829例第一次心内膜炎患者中(平均[SD]年龄,62.3 岁[18.9]; 59.1%为男性),标准化年发病率稳定在每十万人群中7.6(95%CI,7.4〜7.9)和7.8(95%CI ,7.6〜8.0)(百分比变化[APC],-0.06%; 95%CI,-0.3%〜0.2%; P =0.59)。

从1998年至2013年,心内膜炎患者比例从74.5%降至68.4%(APC为-0.7%,95%CI,-0.9%,至-0.5%; P <0.001)。假性心内膜炎的比例增加(从12.0%升至13.8%; APC,1.3%; 95%CI,0.8%至1.7%; P <0.001)。心脏器官相关性心内膜炎增加(从1.3%升至4.1%; APC ,8.8%; 95%CI,7.8%〜9.9%; P <0.001)。

卫生保健相关医院心内膜炎患者比例下降(从17.7%降至15.3%; APC,-1.0%; 95%CI,-1.4%至-0.7%; P <0.001)。卫生保健相关非正规医院心内膜炎患者比例增加(从32.1%升至35.9%; APC,0.8%; 95%CI,0.5%〜1.1%; P <0.001)。

经口链球菌性心内膜炎的发生率没有增加(未调整:APC,-0.1%; 95%CI,-0.8%至0.6%; P = .77;调整:APC,-1.3%; 95%CI,-1.8% -0.7%; P <0.001)。90天粗死亡率未变(从23.9%至24.2%; APC,-0.3%; 95%CI,-1.0%至0.4%; P =0 .44);调整后90天死亡风险降低(每年调整风险比为0.982; 95%CI,0.978至0.986; P <0.001)。

此项研究表明:在加利福尼亚州和纽约州,感染性心内膜炎的总体标准化发病率在1998年至2013年期间稳定,而患者的特征和病因在此期间有所变化。

原始出处:
Toyoda N, Chikwe J, et al. Trends in Infective Endocarditis in California and New York State, 1998-2013. JAMA. 2017 Apr 25;317(16):1652-1660. doi: 10.1001/jama.2017.4287.

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    2017-05-26 luwei00
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    2017-06-17 lofter

    学习了,感谢分享

    0

  5. 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  6. 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    2017-05-01 1dd8c52fm63(暂无匿称)

    了解了解

    0

  7. 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likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLANEL7Sww3HicKsN9aribicAmGGWXOIMEiaZ1iadgZg9RibjqSwIKUS8gSPib2NwTVg2zVvVJhdP3BkuDIl/0, createdBy=944d1605392, createdName=shaosai, createdTime=Sun Apr 30 16:26:06 CST 2017, time=2017-04-30, status=1, ipAttribution=)]
    2017-05-01 flysky120

    中国的病情怎么样?

    0

  8. 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likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLANEL7Sww3HicKsN9aribicAmGGWXOIMEiaZ1iadgZg9RibjqSwIKUS8gSPib2NwTVg2zVvVJhdP3BkuDIl/0, createdBy=944d1605392, createdName=shaosai, createdTime=Sun Apr 30 16:26:06 CST 2017, time=2017-04-30, status=1, ipAttribution=)]
    2017-05-01 飛歌

    学习了很有用

    0

  9. 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likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLANEL7Sww3HicKsN9aribicAmGGWXOIMEiaZ1iadgZg9RibjqSwIKUS8gSPib2NwTVg2zVvVJhdP3BkuDIl/0, createdBy=944d1605392, createdName=shaosai, createdTime=Sun Apr 30 16:26:06 CST 2017, time=2017-04-30, status=1, ipAttribution=)]
    2017-04-30 ylzr123

    不错的方式,努力学习,刻苦专研,不断总结出来新经验。给点个赞!

    0

  10. 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likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLANEL7Sww3HicKsN9aribicAmGGWXOIMEiaZ1iadgZg9RibjqSwIKUS8gSPib2NwTVg2zVvVJhdP3BkuDIl/0, createdBy=944d1605392, createdName=shaosai, createdTime=Sun Apr 30 16:26:06 CST 2017, time=2017-04-30, status=1, ipAttribution=)]
    2017-04-30 shaosai

    好好学习,涨知识

    0

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患者女,60岁,急性胸膜炎性胸痛和呼吸困难就诊,不伴咳痰。病程期间患者经历了不适、间歇热、寒颤4周。10年前患者心脏听证闻及杂音,经胸超声心动图检查后,诊断为动脉导管未闭(PDA)。入院时,患者体温39°C;左侧胸膜摩擦感;前胸导联有机械杂音;心电图未见明显异常;查血提示正常红细胞性贫血、白细胞增多、肾功未见明显异常;三份血液培养均显示B组链球菌;胸片结果如下图:1-患者的胸片结果有什么异常,

Europac:起搏器相关感染性心内膜炎发病率的改变及临床特征(1987-2013)

目的:近年来,心脏起搏装置的应用增加。研究者旨在评估过去27年间(1987年至2013年),与起搏器相关的感染性心内膜炎(IE)的流行病学和临床特征的变化方法:从1987到2013年12月,医院共诊断413例IE。在这期间,共植入起搏器7424个(6917心脏起搏器,239植入式心脏除颤器,158再同步装置,和110个同步/除颤器设备)。所有IE患者均植入心脏起搏器装置。结果:感染性心内膜炎并植入

EHJ:持续感染致感染性心内膜炎患者死亡率增高

临床实践中,抗生素治疗常常不能有效控制感染性心内膜炎病程,进而导致患者死于心衰、血栓、严重败血症或完全性房室传导阻滞的风险增高。根据欧洲指南,这种不能控制的感染包括持续感染,定义为抗生素治疗7-10天后出现发热和持续性血培养阳性。然而,这个分界有点武断,时间可能更长。来自西班牙的一研究小组近期发现左侧感染性心内膜炎在抗生素治疗开始48-72小时后持续性血培养阳性与患者院内死亡率增高密切相关,发表在

Eur Heart J:危重感染性心内膜炎患者死亡率仍持高不下

法国一项研究表明,危重感染性心内膜炎(IE)患者死亡率仍处于不可接受的高位,多达1/3的潜在适宜者未接受手术治疗并且死亡率极高。论文8月20日在线发表于《欧洲心脏杂志》(Eur Heart J)。 此项研究共纳入198例危重IE患者,其中137例(69%)在中位59.5个月随访期间死亡。与死亡率显著相关的特征包括感染ICU入住时相关器官衰竭评分(SOFA)(P=0.003

JAMA:TAVR后感染性心内膜炎的危险因素及临床疗效分析

根据9月13日发表在JAMA的一项研究,接受经导管主动脉瓣置换术,年轻,男性,有糖尿病史,以及中度至重度残余主动脉瓣关闭不全的患者患感染性心内膜炎的风险显著增加,患心内膜炎的患者有较高的住院死亡率高和2年死亡率。1%至6%的患者在接受外科瓣膜置换术后感染性心内膜炎(由于细菌进入血液引起的感染,这些细菌会隐藏在心脏瓣膜或心内膜中),这增加了疾病和死亡的风险。经导管主动脉瓣置换术(TAVR)已成为主动

Heart:感染性心内膜炎的抗生素预防

由此可见,基于AP使用的证据较为有限,许多研究的异质性和方法学质量不佳。术后菌血症不是一个好的IE替代终点。考虑到一项随机试验逻辑上的挑战,高质量的病例-对照研究将有助于评估牙科手术再引起IE中的作用和AP的预防疗效。

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