황색포도알균에 의한 감염성 심내막염의 임상적 특성
Clinical characteristics of infective endocarditis caused by Staphylococcus aureus: A 12-year experience in a tertiary-care hospital
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목적: 최근 황색포도알균 감염성 심내막염은 그 빈도가 지속적으로 늘고 있으나, 국내에서 그 임상상에 대해서는 보고된 연구가 없었다. 이에 본 저자들은 황색포도알균 감염성 심내막염의 역학적, 임상적, 초음파적 특징 등을 알아보고, 다른 원인균의 감염성 심내막염 환자들과 그 특성을 비교하고자 하였다. 방법: 1995년 1월부터 2006년 12월까지 삼성서울병원에서 감염성 심내막염으로 진단받은 304예의 환자에서 modified Duke criteria에 준하여 이 기준에 합당한 감염성 심내막염 환자 285예를 대상으로 자료를 후향적으로 분석하였다.
Abstract
Background/Aims: The risk factors and clinical outcome of infective endocarditis (IE) have changed over the past few decades. Recently, the incidence of Staphylococcus aureus IE (SAIE) has increased. We investigated the clinical and microbiological characteristics and clinical outcomes of SAIE. Methods: All patient cases that were diagnosed as IE according to the modified Duke criteria in Samsung Medical Center during the period of January 1995 to December 2006 were reviewed retrospectively. The clinical and microbiological characteristics of patients with SAIE were compared to those of non-SAIE patients with IE. Results: We enrolled 304 patients with IE. Of these, 240 cases were IE culture-positive, including 73 cases of SAIE. The mean age of patients with SAIE was 48.15±19.87 years, with male patients accounting for 71.2% of our study group. Congenital heart disease (8.2%) was less common among SAIE patients. Hospital-acquired IE was significantly more common in SAIE than in non-SAIE cohorts (p<0.05). Surgical treatment was performed in 33 cases (45.2%). Valvular regurgitation with heart failure was the most frequent cause of surgery (39.3%). Twenty-three cases exhibited complications, including extra cardiac embolization (16.4%) and heart failure (5.6%). Fever persisting for a period longer than seven days was more common among those in the SAIE group. Twelve patients (16.4%) died and four patients (5.4%) were discharged without hope of improvement. The in-hospital mortality rate was higher among SAIE patients (17.3%) compared to that among non-SAIE patients (11%), although this comparison was not statistically distinct (p> 0.05). Methicillin resistance and non-surgical treatment were significant risk factors for in-hospital mortality. Conclusions: SAIE is more strongly associated with systemic embolization, persistent fever, and longer hospital stays compared to non-SAIE. Further studies are warranted to evaluate adequate treatment and to improve the outcome of patients with SAIE.
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