녹색사슬알균 균혈증 환자에서 감염성 심내막염의 관련인자와 사망의 예측인자 (Factors Associated with Infective Endocarditis and Predictors of 3-month mortality of Patients with Viridans Streptococcal Bacteremia)

서지정보

· 발행기관 : 대한감염학회
· 수록지 정보 : Infection and Chemotherapy / 44권 / 6호 / 419 ~ 425페이지
· 저자명 : 서영선, 김민교, 허재형, 조오현, 김장락, 김선주, 배인규

초록

Background: Viridans streptococci is a major pathogen of infective endocarditis.
This study was conducted in order to investigate the factors associated with infective endocarditis and predictors for three-month mortality among patients with viridans streptococcal bacteremia (VSB).
Materials and Methods: In this study, among 261 eligible patients diagnosed as VSB from January 2000 through June 2011 in a university-affiliated hospital, a retrospective analysis of 197 patients was conducted. All patients with VSB were classified into two groups according to sites of bacteremia; infective endocarditis and other infections. Demographic and clinical characteristics were reviewed through electronic medical records factors associated with infective endocarditis and predictors of three-month mortality in VSB patients were evaluated.
Results: Of the 197 patients, 37 (18.8%) patients had viridans streptococcal infective endocarditis (VSIE) and 160 (81.2%) patients had VSB due to other infection. In logistic regression analysis, underlying valvular heart disease (odds ratio [OR],48.43; 95% confidence interval [CI], 5.77-406.38) and persistent bacteremia (OR,46.32; 95% CI, 7.18-299.01) showed an independent association with VSIE. Threemonth mortality rate was 21.7% in patients with VSB. In logistic regression analysis,previous steroid use (OR, 9.31; 95% CI, 1.34-64.52), previous immunosuppressive therapy (OR, 9.50; 95% CI, 2.13-42.30), hypotension at onset of bacteremia (OR,7.72, 95% CI, 2.45-24.33), and Charlson comorbidity score ≥3 (OR, 4.53, 95% CI,1.55-13.28) showed an independent association with three-month mortality in patients with VSB.
Conclusions: VSB patients who have valvular heart disease or persistent bacteremia routinely require echocardiography. Previous steroid use, immunosuppressive therapy, hypotension, and higher Charlson comorbidity score suggested poor prognosis in patients with VSB.

영어초록

Background: Viridans streptococci is a major pathogen of infective endocarditis.
This study was conducted in order to investigate the factors associated with infective endocarditis and predictors for three-month mortality among patients with viridans streptococcal bacteremia (VSB).
Materials and Methods: In this study, among 261 eligible patients diagnosed as VSB from January 2000 through June 2011 in a university-affiliated hospital, a retrospective analysis of 197 patients was conducted. All patients with VSB were classified into two groups according to sites of bacteremia; infective endocarditis and other infections. Demographic and clinical characteristics were reviewed through electronic medical records factors associated with infective endocarditis and predictors of three-month mortality in VSB patients were evaluated.
Results: Of the 197 patients, 37 (18.8%) patients had viridans streptococcal infective endocarditis (VSIE) and 160 (81.2%) patients had VSB due to other infection. In logistic regression analysis, underlying valvular heart disease (odds ratio [OR],48.43; 95% confidence interval [CI], 5.77-406.38) and persistent bacteremia (OR,46.32; 95% CI, 7.18-299.01) showed an independent association with VSIE. Threemonth mortality rate was 21.7% in patients with VSB. In logistic regression analysis,previous steroid use (OR, 9.31; 95% CI, 1.34-64.52), previous immunosuppressive therapy (OR, 9.50; 95% CI, 2.13-42.30), hypotension at onset of bacteremia (OR,7.72, 95% CI, 2.45-24.33), and Charlson comorbidity score ≥3 (OR, 4.53, 95% CI,1.55-13.28) showed an independent association with three-month mortality in patients with VSB.
Conclusions: VSB patients who have valvular heart disease or persistent bacteremia routinely require echocardiography. Previous steroid use, immunosuppressive therapy, hypotension, and higher Charlson comorbidity score suggested poor prognosis in patients with VSB.

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