达托霉素治疗感染性心内膜炎26例分析  

Analysis of 26 cases of infective endocarditis treated with daptomycin

作　　者：夏静鸿[1] 张雪冬[1] 李坑[1] 吴立松[1] 朱光发[1] XIA Jinghong;ZHANG Xuedong;LI Keng;ZHU Guangfa(Department of Infectious Diseases,Beijing Anhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所感染科,100029

出　　处：《心肺血管病杂志》2021年第6期578-582,587,共6页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨达托霉素在治疗革兰阳性球菌引起的不同类型感染性心内膜炎(IE)的临床治疗效果。方法:回顾性分析26例应用达托霉素治疗的IE住院患者,对其临床资料进行分析。结果:26例患者均为补救治疗。以左心IE为主(占84.6%),瓣膜表现以赘生物最多见(占88.5%),近50%患者瓣膜损害呈多种表现(12例,占46.2%)。76.9%患者血培养阳性,其中凝固酶阴性葡萄球菌居多(占血培养阳性者的70%),甲氧西林耐药菌株为主(仅1例溶血葡萄球菌为甲氧西林敏感菌)。所有入组患者在更换达托霉素前均应用了多种抗微生物药物;更换达托霉素的原因大多因为感染控制不佳(19例,占73.1%),22例患者为联合用药(占84.6%)。应用达托霉素期间,15例患者体温可恢复正常(占57.7%);7例患者体温未恢复正常(占26.9%)。13例患者进行心脏瓣膜手术或更换中心静脉置管及拔除心脏起搏器操作(共占50%)。治愈停药及治疗好转出院继续用药者14例(占53.8%);患者病情仍加重家属放弃治疗自动出院或院内死亡患者共9例(占34.6%)。结论:初步观察达托霉素用于初始治疗失败的IE病例的补救治疗可取得一定疗效。Objective:To investigate the clinical effect of daptomycin in the treatment of different types of infective endocarditis caused by gram-positive cocci.Methods:26 cases of infective endocarditis treated with daptomycin were retrospectively analyzed.The clinical features,infection site,pathogenic bacteria,echocardiography,operation,clinical medication and prognosis were analyzed.Results:All 26 patients were treated with salvage therapy.Most of the patients had left ventricular ie(84.6%),the most common valve manifestations were vegetations(88.5%).76.9%of the patients were positive for blood culture,of which coagulase negative Staphylococcus was the most(accounting for 70.0%of the positive blood culture),and most of them were methicillin resistant strains(only one case of hemolytic Staphylococcus was methicillin sensitive).All the patients were treated with a variety of anti microbial drugs before the replacement of daptomycin;Most of the reasons for replacing daptomycin were due to poor infection control(73.1%),and most of the patients were combined drugs(84.6%).During the application of daptomycin,the body temperature of most patients returned to normal(57.7%);the temperature of 7 patients did not return to normal(26.9%).Half of the patients underwent cardiac valve operation or replacement of central venous catheter and removal of cardiac pacemaker(50%).Among them,53.8%of the patients were cured and stopped taking medicine,and 9 patients(34.6%)died after their families gave up treatment.Conclusions:It is preliminarily observed that daptomycin can be used as a salvage treatment for infective endocarditis patients whose initial treatment failed.

关 键 词：感染性心内膜炎 达托霉素 补救治疗 

分 类 号：R54[医药卫生—心血管疾病]