Splenic abscess and infective endocarditis.

IF 5.4 2区医学 Q1 INFECTIOUS DISEASES

Infection Pub Date : 2025-02-01 Epub Date: 2024-06-25 DOI:10.1007/s15010-024-02322-w

Monique Boukobza, Lionel Rebibo, Emila Ilic-Habensus, Bernard Iung, Xavier Duval, Jean-Pierre Laissy

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引用次数: 0

Abstract

Objective: To determine the background, bacteriological, clinical and radiological findings, associated lesions, treatment and outcome of splenic abscesses (SAs) in infective endocarditis (IE).

Methods: Retrospective study (2005-2021) of 474 patients with definite IE. The diagnosis of SA was made in 36 (7.6%) patients (31, 86.1%, males, mean age = 51.3) on abdominal CT.

Results: The main implicated organisms were Streptococcus spp (36.1%), Enterococcus faecalis (27.7%), Staphyloccus spp (19.4%). Rare agents were present in 10 patients (27.8%). Pre-existing conditions included a prosthetic valve (19.4%), previous IE (13.9%), intravenous drug use (8.4%), diabetes (25%) alcohol abuse (13.9%), liver disease (5.5%). Vegetations ≥ 15 mm were present in 36.1%. Common presentations were abdominal pain (19.4%) and left-sided pleural effusion (16.5%). SA were more often small (50%; 7 multiple) than large (36.1%; 1 multiple) or microabscesses (13.9%, 3 multiple). Associated complications were extrasplenic abscesses (brain, 11.1%; lung, 5.5%; liver, 2.8%), infectious aneurysms (16.7%: 3 intracranial, 1 splenic, 1 hepatic, 1 popliteal), emboli (brain, 52.8%; spleen, 44.4%, 5 evolving to SA; kidney, 22.2%; aorta, 2.8%), osteoarticular infections (25%). Twenty-eight (77.8%) patients only received antimicrobials, 7 (19.4%) underwent splenectomy, after cardiac surgery in 5. One had percutaneous drainage. The outcome was uneventful (follow-up 3 months-14 years; mean: 17.2 months).

Conclusion: In SA-IE patients, the prevalence of vegetation size, Enterococcus faecalis, rare germs, diabetes, osteo-arthritic involvement and cancer was higher than in non-SA patients. Some SAs developed from splenic infarcts. IE-patients with evidence of splenic emboli should be evaluated for a possible abcedation. Cardiac surgery before splenectomy was safe.

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脾脓肿和感染性心内膜炎。

目的：确定感染性心内膜炎（IE）脾脓肿的背景、细菌学、临床和放射学发现、相关病变、治疗和预后：确定感染性心内膜炎（IE）脾脓肿（SA）的背景、细菌学、临床和放射学发现、相关病变、治疗和结果：方法：对474例确诊为IE的患者进行回顾性研究（2005-2021年）。36例（7.6%）患者（31例，86.1%，男性，平均年龄=51.3岁）通过腹部CT确诊为脾脓肿：主要病原菌为链球菌（36.1%）、粪肠球菌（27.7%）和葡萄球菌（19.4%）。10名患者（27.8%）感染了罕见病原体。既往疾病包括人工瓣膜（19.4%）、既往 IE（13.9%）、静脉注射毒品（8.4%）、糖尿病（25%）、酗酒（13.9%）、肝病（5.5%）。36.1%的患者有≥15毫米的包块。常见表现为腹痛（19.4%）和左侧胸腔积液（16.5%）。SA多为小脓肿（50%；7个多发），而非大脓肿（36.1%；1个多发）或微脓肿（13.9%，3个多发）。相关并发症包括脾外脓肿（脑，11.1%；肺，5.5%；肝，2.8%）、感染性动脉瘤（16.7%：3 个颅内动脉瘤、1 个脾动脉瘤、1 个肝动脉瘤、1 个腘动脉瘤）、栓子（脑，52.8%；脾，44.4%，5 个演变为 SA；肾，22.2%；主动脉，2.8%）、骨关节感染（25%）。28名患者（77.8%）只接受了抗菌药物治疗，7名患者（19.4%）接受了脾脏切除术，5名患者在心脏手术后接受了脾脏切除术。一人进行了经皮引流。结果一切顺利（随访 3 个月至 14 年；平均：17.2 个月）：结论：在 SA-IE 患者中，植被大小、粪肠球菌、罕见病菌、糖尿病、骨关节炎和癌症的发病率高于非 SA 患者。一些 SA 由脾梗塞发展而来。有证据表明存在脾栓塞的 IE 患者应进行评估，以确定是否可能发生脾栓塞。脾切除术前进行心脏手术是安全的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Infection 医学-传染病学

CiteScore

12.50

自引率

1.30%

发文量

224

审稿时长

6-12 weeks

期刊介绍： Infection is a journal dedicated to serving as a global forum for the presentation and discussion of clinically relevant information on infectious diseases. Its primary goal is to engage readers and contributors from various regions around the world in the exchange of knowledge about the etiology, pathogenesis, diagnosis, and treatment of infectious diseases, both in outpatient and inpatient settings. The journal covers a wide range of topics, including: Etiology: The study of the causes of infectious diseases. Pathogenesis: The process by which an infectious agent causes disease. Diagnosis: The methods and techniques used to identify infectious diseases. Treatment: The medical interventions and strategies employed to treat infectious diseases. Public Health: Issues of local, regional, or international significance related to infectious diseases, including prevention, control, and management strategies. Hospital Epidemiology: The study of the spread of infectious diseases within healthcare settings and the measures to prevent nosocomial infections. In addition to these, Infection also includes a specialized "Images" section, which focuses on high-quality visual content, such as images, photographs, and microscopic slides, accompanied by brief abstracts. This section is designed to highlight the clinical and diagnostic value of visual aids in the field of infectious diseases, as many conditions present with characteristic clinical signs that can be diagnosed through inspection, and imaging and microscopy are crucial for accurate diagnosis. The journal's comprehensive approach ensures that it remains a valuable resource for healthcare professionals and researchers in the field of infectious diseases.