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Impact of Valve Culture in the Prognosis of Active Left-sided Infective Endocarditis.
Clinical Infectious Diseases ( IF 8.2 ) Pub Date : 2019-03-05 , DOI: 10.1093/cid/ciy684
Pablo Elpidio García-Granja 1, 2 , Javier López 1, 2 , Isidre Vilacosta 3 , Cristina Sarriá 4 , Raquel Ladrón 1 , Carmen Olmos 3 , Carmen Sáez 4 , Luis Maroto 3 , Salvatore Di Stefano 1 , Itziar Gómez 1 , J Alberto San Román 1, 2 ,
Affiliation  

BACKGROUND The culture of removed cardiac tissues during cardiac surgery of left-sided infective endocarditis (LSIE) helps to guide antibiotic treatment. Nevertheless, the prognostic information of a positive valve culture has never been explored. METHODS Among 1078 cases of LSIE consecutively diagnosed in 3 tertiary centers, we selected patients with positive blood cultures who underwent surgery during the active period of infection and in whom surgical biological tissues were cultured (n = 429). According to microbiological results, we constructed 2 groups: negative valve culture (n=218) and concordant positive valve culture (CPVC) (n=118). We compared their main features and performed a multivariable analysis of in-hospital mortality. RESULTS Patients with CPVC presented more nosocomial origin (32% vs 20%, P = .014), more septic shock (21% vs 11%, P = .007), and higher Risk-E score (29% vs 21%, P = .023). Their in-hospital mortality was higher (35% vs 19%, P = .001), despite an earlier surgery (3 vs 11 days from antibiotic initiation, P < .001). Staphylococcus species (61% vs 42%, P = .001) and Enterococcus species (20% vs 9%, P = .002) were more frequent in the CPVC group, whereas Streptococcus species were less frequent (14% vs 42%, P < .001). Independent predictors for in-hospital mortality were renal failure (odds ratio [OR], 2.6 [95% confidence interval {CI}, 1.5-4.4]), prosthesis (OR, 1.9 [95% CI, 1.1-3.5]), Staphylococcus aureus (OR, 1.8 [95% CI, 1.02-3.3]), and CPVC (OR, 2.3 [95% CI, 1.4-3.9]). CONCLUSIONS Valve culture in patients with active LSIE is an independent predictor of in-hospital mortality.

中文翻译:

瓣膜培养对活动性左侧感染性心内膜炎预后的影响。

背景技术在左侧感染性心内膜炎(LSIE)的心脏手术期间培养去除的心脏组织有助于指导抗生素治疗。然而,从未探讨过阳性瓣膜文化的预后信息。方法在3个三级中心连续诊断的1078例LSIE病例中,我们选择了在感染活动期间接受手术并培养了手术生物组织的血液培养阳性的患者(n = 429)。根据微生物学结果,我们分为2组:负瓣膜培养(n = 218)和一致正瓣膜培养(CPVC)(n = 118)。我们比较了它们的主要特征,并对医院内死亡率进行了多变量分析。结果CPVC患者表现出更多的医院起源(32%vs 20%,P = .014),感染性休克的发生率更高(21%vs. 11%,P = .007),Risk-E评分更高(29%vs 21%,P = .023)。尽管进行了更早的手术(抗生素开始后3到11天,P <.001),他们的院内死亡率还是更高(35%比19%,P = .001)。在CPVC组中,葡萄球菌种类(61%vs 42%,P = .001)和肠球菌种类(20%vs 9%,P = .002)更为频繁,而链球菌种类则较少(14%vs 42%, P <.001)。院内死亡率的独立预测因子是肾衰竭(几率[OR],2.6 [95%置信区间{CI},1.5-4.4]),假体(OR,1.9 [95%CI,1.1-3.5]),葡萄球菌金黄色葡萄球菌(OR,1.8 [95%CI,1.02-3.3])和CPVC(OR,2.3 [95%CI,1.4-3.9])。结论活动性LSIE患者的瓣膜培养是院内死亡率的独立预测因子。以及更高的Risk-E得分(29%比21%,P = .023)。尽管进行了较早的手术(抗生素开始后3天与11天,P <.001),他们的院内死亡率仍较高(35%比19%,P = .001)。在CPVC组中,葡萄球菌种类(61%vs 42%,P = .001)和肠球菌种类(20%vs 9%,P = .002)更为频繁,而链球菌种类则较少(14%vs 42%, P <.001)。院内死亡率的独立预测因子是肾衰竭(几率[OR],2.6 [95%置信区间{CI},1.5-4.4]),假体(OR,1.9 [95%CI,1.1-3.5]),葡萄球菌金黄色葡萄球菌(OR,1.8 [95%CI,1.02-3.3])和CPVC(OR,2.3 [95%CI,1.4-3.9])。结论活动性LSIE患者的瓣膜培养是院内死亡率的独立预测因子。以及更高的Risk-E得分(29%比21%,P = .023)。尽管进行了更早的手术(抗生素开始后3到11天,P <.001),他们的院内死亡率还是更高(35%比19%,P = .001)。在CPVC组中,葡萄球菌种类(61%vs 42%,P = .001)和肠球菌种类(20%vs 9%,P = .002)更为频繁,而链球菌种类则较少(14%vs 42%, P <.001)。院内死亡率的独立预测因子是肾衰竭(几率[OR],2.6 [95%置信区间{CI},1.5-4.4]),假体(OR,1.9 [95%CI,1.1-3.5]),葡萄球菌金黄色葡萄球菌(OR,1.8 [95%CI,1.02-3.3])和CPVC(OR,2.3 [95%CI,1.4-3.9])。结论活动性LSIE患者的瓣膜培养是院内死亡率的独立预测因子。尽管手术较早(抗生素开始后3天比11天,P <.001)。在CPVC组中,葡萄球菌种类(61%vs 42%,P = .001)和肠球菌种类(20%vs 9%,P = .002)更为频繁,而链球菌种类则较少(14%vs 42%, P <.001)。院内死亡率的独立预测因子是肾衰竭(几率[OR],2.6 [95%置信区间{CI},1.5-4.4]),假体(OR,1.9 [95%CI,1.1-3.5]),葡萄球菌金黄色葡萄球菌(OR,1.8 [95%CI,1.02-3.3])和CPVC(OR,2.3 [95%CI,1.4-3.9])。结论活动性LSIE患者的瓣膜培养是院内死亡率的独立预测因子。尽管手术较早(抗生素开始后3天比11天,P <.001)。在CPVC组中,葡萄球菌种类(61%vs 42%,P = .001)和肠球菌种类(20%vs 9%,P = .002)更为频繁,而链球菌种类则较少(14%vs 42%, P <.001)。院内死亡率的独立预测因子是肾衰竭(几率[OR],2.6 [95%置信区间{CI},1.5-4.4]),假体(OR,1.9 [95%CI,1.1-3.5]),葡萄球菌金黄色葡萄球菌(OR,1.8 [95%CI,1.02-3.3])和CPVC(OR,2.3 [95%CI,1.4-3.9])。结论活动性LSIE患者的瓣膜培养是院内死亡率的独立预测因子。002)在CPVC组中更为频繁,而链球菌属物种则较少(14%对42%,P <.001)。院内死亡率的独立预测因子是肾衰竭(几率[OR],2.6 [95%置信区间{CI},1.5-4.4]),假体(OR,1.9 [95%CI,1.1-3.5]),葡萄球菌金黄色葡萄球菌(OR,1.8 [95%CI,1.02-3.3])和CPVC(OR,2.3 [95%CI,1.4-3.9])。结论活动性LSIE患者的瓣膜培养是院内死亡率的独立预测因子。002)在CPVC组中更为频繁,而链球菌属物种则较少(14%对42%,P <.001)。院内死亡率的独立预测因子是肾衰竭(几率[OR],2.6 [95%置信区间{CI},1.5-4.4]),假体(OR,1.9 [95%CI,1.1-3.5]),葡萄球菌金黄色葡萄球菌(OR,1.8 [95%CI,1.02-3.3])和CPVC(OR,2.3 [95%CI,1.4-3.9])。结论活动性LSIE患者的瓣膜培养是院内死亡率的独立预测因子。
更新日期:2019-03-05
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