目的 探讨葡萄球菌感染性心内膜炎(IE)患者的临床和病原学特征,为临床诊治提供依据。方法 对北京协和医院2011年至2018年住院治疗的46例葡萄球菌IE患者进行回顾性分析。结果 本组46例葡萄球菌IE,占同期诊断的425例IE总数的10.8%。发热(97.8%)是最常见的临床表现,其次是贫血(73.3%)和心脏杂音(63.0%)。并发症主要是心力衰竭(52.2%)和脏器栓塞(43.5%)。病原菌为金黄色葡萄球菌的38例(82.6%),其中甲氧西林耐药菌株12例(31.6%);病原菌为凝固酶阴性葡萄球菌的8例(17.4%),其中甲氧西林耐药菌株6例(75.0%)。住院期间死亡4例(8.7%)。与链球菌IE患者相比,葡萄球菌IE有基础慢性疾病的比例更高(P=0.008),并发感染性休克的比例更高(P<0.01);累及左心的比例较低(P<0.01),累及人工瓣膜/装置的比例较高(P<0.01),出现脓肿形成的比例较高(P=0.005);住院期间死亡/未愈的比例较高(P=0.015)。结论 葡萄球菌是IE重要的致病菌,相比链球菌IE而言,葡萄球菌IE病情进展更快,合并基础慢性疾病和并发症更多,预后更差,这使得葡萄球菌IE的临床治疗更具挑战性。

Objective The purpose of this paper is to explore the clinical and etiological characteristic of patients with staphylococcus infective endocarditis (IE), to provide evidence for diagnosis and treatment.Methods This retrospective study included a cohort of 46 staphylococcus IE patients hospitalized in Peking Union Medical College Hospital from 2011 to 2018.Results The incidence of staphylococcus IE was 46 cases, accounted for 10.8% among 425 IE inpatients at the same time. Fever (97.8%) was the most common clinical presentation, followed by anemia (73.3%) and cardiac murmur (63.0%). Congestive heart failure (52.2%) and embolism (43.5%) were the most common complications. Among 46 staphylococcus strains, 38 stains (82.6%) were S. aureus (percentage of methicillin-resistant was 31.6%), while 8 strains (17.4%) were S. coagulase negative (percentage of methicillin-resistant was 75.0%). Four (8.7%) died during hospitalization. Compared with streptococcus IE, staphylococcus IE was associated with higher prevalence of underlying chronic disease (P=0.008), higher prevalence of complicated septic shock (P<0.01), lower prevalence of left side IE (P<0.01) and higher prevalence of prosthetic valves/devices (P<0.01); abscess formation were more frequent in staphylococcus IE (P=0.005). Inpatients with staphylococcus IE were more likely to have higher mortality and/or non-healing rate (P=0.015).Conclusion Staphylococcus (mostly S. aureus) is an important pathogen of IE. Compared with Streptococcus IE, patients with staphylococcus IE are likely to have more severe disease, more comorbidities and complications, and a poor prognosis. Management of staphylococcus IE is a challenge to physicians.