Clinical Features and Outcome of Infective Endocarditis in Maintenance Hemodialysis Patients

感染性心內膜炎在血液透析患者的臨床表徵及預後

吳逸文(I-Wen Wu) ； 陳永昌(Yung-Chang Chen) ； 田亞中(Ya-Chung Tian) ； 方基存(Ji-Tseng Fang) ； 楊智偉(Chih-Wei Yang)

《Acta Nephrologica》 19卷1期 (2005/03) Pp. 9-13

摘要

背景：縱使診斷技術、抗生素研發和心臟瓣膜手術治療的進步，目前感染性心內膜炎在血液透析患者的死夭率仍然偏高，故我們設計本實驗來討論造成這類病人院內死夭之預後因子。
方法：在這溯往性研究中，於1994年元月至2004年十二月，長庚紀念醫院林口醫學中心所有血液透析病患併發感染性心內膜炎，其臨床資料和各項生化檢驗都納入研究。總共有20名這類患者，使用修飾後杜克標準判別：16位屬確定感染性心內膜炎，4位為可能感染性心內膜炎。
結果：使用自身瘻管佔所有血管通路的50%，二尖瓣是最容易被感染的瓣膜，金黃色葡萄球菌是最常見造成感染性心內膜炎的菌種，住院死亡率為35%。大多數死亡病人和住院當日白血球數目增多、曾接受侵襲性檢查或治療病史、和感染性心內膜炎由青oxacillin抗藥性金黃色葡萄球菌(ORSA)引起有關。
結論：本研究確認：血液透析患者罹患感染性心內膜炎的預後不佳。住院當日白血球增多、最近曾接受侵襲性檢查或治療、和ORSA心內膜炎是這些病人預後不佳之重要因子。

關鍵字

菌血症 ； 心內膜炎 ； 血液透析 ； 白血球增多 ； oxacillin抗藥性金黃色葡萄球菌

並列摘要

Background: Despite improved diagnostic maneuvers, antimicrobial agents, and more sophisticated valve replacement, the mortality of infective endocarditis (IE) in dialysis patients remains high. This investigation is aimed to identify the prognostic factors for hospital mortality in patients on hemodialysis with IE.
Method: A retrospective study was conducted through reviewing the records of all patients on maintenance hemodialysis who developed IE at Chang Gung Memorial Hospital between January 1994 and December 2004. According to the modified-Duke criteria, a total of 20 dialysis patients with IE were identified, 16 dialysis patients with definite IE and four with possible IE.
Result: The native fistulas were used in 50% of all angioaccess. The mitral valve was the most commonly affected valve. The most common pathogen was Staphylococci aureus (45%). The overall hospital-mortality rate was 35%. Death in the majority of patients was related to elevated leukocyte count on admission, previous history of endovascular procedure, and IE due to oxacillin-resistant Staphylococcus aureus (ORSA). Conclusion: This investigation confirms that the prognosis for dialysis-related IE is grave. The presence of initial leukocytosis, recent invasive procedure, and ORSA endocarditis indicate poor prognosis in these patients.

並列關鍵字

bacteremia ； endocarditis ； hemodialysis ； leukocytosis ； ORSA