Hospital therapy. Etiology of infective endocarditis (IE) (most important)

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Hospital therapy. Etiology of infective endocarditis (IE) (most important)

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17. Etiology of infective endocarditis (IE)

Infective endocarditis (IE) is a disease consisting in a polyposis-ulcerative lesion of the valvular apparatus of the heart (often with the development of valvular insufficiency) or parietal endocardium (less often, the endothelium of the aorta or the nearest large artery is affected). The disease is caused by various pathogenic microorganisms and is accompanied by a systemic lesion of the internal organs (kidneys, liver, spleen) against the background of an altered reactivity of the organism.

Etiology. The pathogenic causative agents of the disease are most often the coccal group of microorganisms - streptococci (viridans streptococcus was previously isolated in 90% of cases), staphylococci (golden, white), enterococcus, pneumococcus. In recent years, due to the widespread use of antibiotics, the range of microbial pathogens has changed. The disease can be caused by gram-negative flora (Escherichia coli, Pseudomonas aeruginosa, Proteus, Klebsiella); evidence has emerged of the important role of pathogenic fungi, Sarcinus, Brucella and viruses. Diseases caused by these pathogens are more severe, especially endocarditis caused by a fungal infection (usually occurs due to irrational use of antibiotics). However, in some patients the true causative agent of the disease is not detected (negative blood culture rate 20-50%).

Often, infection occurs at the site of a prosthetic valve - the so-called prosthetic IE, which develops mainly within 2 months after heart valve replacement surgery. In this case, the causative agent of the disease most often has a streptococcal nature.

Thus, the sources of infection and bacteremia in IE are very diverse (oral surgery, surgery and diagnostic procedures in the urogenital area, surgery on the cardiovascular system (including valve replacement), prolonged stay of the catheter in a vein, frequent intravenous infusions and endoscopic methods studies, chronic hemodialysis (arteriovenous shunt), intravenous drug administration).

There are so-called primary IE, which developed on intact valves, as well as IE against the background of congenital and acquired changes in the heart and its valvular apparatus - secondary endocarditis. These changes make it possible to distinguish patients into separate risk groups: heart defects (congenital and acquired), mitral valve prolapse, arteriovenous aneurysms, post-infarction aneurysms, shunts, condition after surgery on the heart and large vessels.

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