背景:感染性心内膜炎(IE)仍然是一种严重的疾病,发病率和死亡率升高。然而,最新的欧洲指南(GL)可以追溯到2015年,最近的一项调查描述了对其建议的弥漫性次优依从性.这里,我们描述了一个关于坚持IE治疗GL的真实情景。
方法:这是一个回顾性研究,多中心,病例对照研究。2016年至2020年入住我们病房的所有IE病例均已登记。患者分为两组,根据不依从性(A组,病例)或依从性(B组,控制)符合2015年ESC指南。仅考虑有针对性的治疗。群体进行了人口统计学比较,临床,微生物,以及实验室数据和结果。作为事后分析,我们分析了偏离指南的特点,以及这些偏离对死亡率的影响.
结果:共纳入246例患者,A组128例(52%),B组118例(48%),除病因外,各组均相同:葡萄球菌和血培养阴性的IE在A组中更常见,而B组链球菌和肠球菌性IE更常见(p<0.001)。两组的住院死亡率相当。偏离指南的最常见原因是使用达托霉素,除了标准治疗和缺少利福平或庆大霉素的给药。
结论:对2015年ESC指南的依从性有限,但不影响死亡率。
BACKGROUND: Infective endocarditis (IE) is still a severe disease with elevated morbidity and mortality. Nevertheless, the last European
guidelines (GL) date back to 2015, and a recent survey described a diffuse suboptimal adherence to their recommendations. Here, we described a real-life scenario about adherence to IE treatment GL.
METHODS: This was a retrospective, multicentric, case-control study. All the cases of IE admitted to our wards from 2016 to 2020 were enrolled. Patients were divided into two groups, according to the non-adherence (group A, cases) or adherence (group B, controls) to 2015 ESC
guidelines. Only targeted treatments were considered. Groups were compared for demographic, clinical, microbiological, and laboratory data and outcome. As a post hoc analysis, we analysed the characteristics of deviations from the
guidelines and how these deviations affected mortality.
RESULTS: A total of 246 patients were enrolled, with 128 (52%) in group A and 118 (48%) in group B. Groups were homogeneous except for aetiologies: staphylococcal and blood-culture-negative IE were more frequent in group A, while streptococcal and enterococcal IE were more frequent in group B (p < 0.001). In-hospital mortality was comparable in the two groups. The most frequent causes of deviations from the
guidelines were use of daptomycin, in addition to standard treatments and the missing administration of rifampin or gentamycin.
CONCLUSIONS: Adherence to 2015 ESC
guidelines was limited but it did not affect mortality.