Abstract
Infective endocarditis (IE) caused by Gram-negative bacteria is a rare and insufficiently characterized form of endocarditis. The literature review presents data on the frequency, course, risk factors, diagnosis and treatment of both IE caused by the HACEK microorganisms (Haemophilus spр., Aggregatibacter spp., Cardiobacterium hominis, Eikenella corrodens, Kingella) and other Gram-negative bacteria. Gram-negative bacteria are the cause of 3.6–13.6 % IE cases (HACEK microorganisms in 0.8–3 % of IE cases in adults, non-HACEK in 1.8–3.9 %). Patients with IE caused by the HACEK microorganisms are younger, their disease is not associated with previous in-hospital treatment and is subacute with favorable prognosis (intrahospital mortality is 2–3 %). HACEK microorganisms mostly retain sensitivity to many antibiotics. Risk factors of IE caused by HACEK microorganisms are dental interventions, heart disorders, valve prostheses and other implanted cardiac devices. IE caused by non-HACEK Gram-negative bacteria is more common in elderly with concomitant disorders and usually is acute; intrahospital mortality is 13–36.5 %. Risk factors of IE caused by non-HACEK microorganisms are valve prostheses, electrical pacemakers, venous and central catheters, recent in-hospital treatment, Gram-negative bacteremia, decreased immunity, drug abuse, urinary infection, alcoholism, cirrhosis of the liver, removed spleen, consequences of dog and cat bites, working with the soil. Among Gram-negative non-HACEK bacteria causing IE, 28 % have multi-drug resistance (MDR / XDR) against antibiotics. Therefore, Gram-negative bacteria rarely cause IE but during selection of empiric therapy in patients with IE with corresponding risk factors, probability of Gram-negative causative microorganisms in IE etiology should be taken into account.
Highlights
Ключевые слова: инфекционный эндокардит; инфекционный эндокардит, вызванный бактериями HACEK груп‐ пы; инфекционный эндокардит, вызванный грамотрицательными бактериями; бактериемия, бактерии группы HACEK, эндокардит протезированного клапана, Haemophilus spр., Aggregatibacter spp., Cardiobacterium hominis, Eikenella corrodens, Kingella, Pseudomonas aeruginosa, Serratia marcescens, антибактериальная терапия, мультире‐ зистентность
The literature review presents data on the frequency, course, risk factors, diagnosis and treatment of both Infective endocarditis (IE) caused by the HACEK microorganisms (Haemophilus spр., Aggregatibacter spp., Cardiobacterium hominis, Eikenella corrodens, Kingella) and other Gram-negative bacteria
Patients with IE caused by the HACEK
Summary
Перенесшие операцию по протезированию клапанов сердца менее года назад (ранний ИЭ протеза клапанов) Patients who underwent valve prosthesis surgery less than a year prior (early prosthetic valve IE). Перенесшие операцию по протезированию клапанов сердца более года назад (поздний ИЭ протеза клапанов) Patients who underwent valve prosthesis surgery more than a year prior (late prosthetic valve IE). Наркоманы (внутривенное введение наркотиков), госпитализированные пациенты с внутривенными катетерами и другими внутрисосудистыми устройствами Drug addicts (intravenous drugs), hospitalized patients with intravenous catheters and other intravascular devices. Больные с постоянными внутрисердечными устройствами (электрокардиостимуляторами) Patients with permanent intracardiac devices (electrical pacemakers). Пациенты с заболеваниями и инфекциями мочеполовой системы, после вмешательств на мочеполовых путях, родов, аборта Patients with diseases and infections of the urogenital tract, after urogenital interventions, labor, abortions. Включая инфекции Patients with chronic skin disorders including infections. Пациенты с плохим состоянием зубов, после стоматологических лечебных процедур Patients with poor condition of the teeth, after dental treatment
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