황색포도알균이 가장 흔한 원인인 우리나라 4개 대학병원의 감염성심내막염의 특징

서성우,김태형,현민수,추은주,전민혁,문철,송단,김종화,이용관,최종효,전웅,조영신,최문한 대한감염학회 2008 Infection and Chemotherapy Vol.40 No.6

Background : To evaluate whether Staphylococcus aureus is actually the leading cause of infective endocarditis in Korea, investigation on updated clinical pictures, treatments, and prognosis was performed. This study also aims to describe differences in clinical characteristics of infective endocarditis in patients undergoing maintenance hemodialysis. Materials and Methods : Fifty five patients who were diagnosed with infective endocarditis, using modified Duke criteria, at 4 Soon Chun Hyang University Hospitals (located in Seoul, Bucheon, Cheonan, and Gumi) from January of 2000 to June of 2007 were enrolled. Patients were separated into two groups; those on hemodialysis and those who were not on hemodialysis (control group). Medical records and laboratory results of each patient were reviewed retrospectively. Results : The positive rate of blood culture was 72.7%. Staphylococcus aureus was isolated in 38.2% of the patients, making it the most common causative organism of infective endocarditis. It was also the most common organism in both hemodialysis group and non-hemodialysis group. Six patients (10.9%) died while admitted to the hospital and the in-hospital death rate for hemodialysis group was significantly higher. Conclusion : In most parts of the world, S. aureus is increasingly becoming the principal causative organism of infective endocarditis. To our knowledge, this is the first study that shows S. aureus to be the most common causative organism of infective endocarditis in Korea, and that Korea is not except from this global epidemiology. Background : To evaluate whether Staphylococcus aureus is actually the leading cause of infective endocarditis in Korea, investigation on updated clinical pictures, treatments, and prognosis was performed. This study also aims to describe differences in clinical characteristics of infective endocarditis in patients undergoing maintenance hemodialysis. Materials and Methods : Fifty five patients who were diagnosed with infective endocarditis, using modified Duke criteria, at 4 Soon Chun Hyang University Hospitals (located in Seoul, Bucheon, Cheonan, and Gumi) from January of 2000 to June of 2007 were enrolled. Patients were separated into two groups; those on hemodialysis and those who were not on hemodialysis (control group). Medical records and laboratory results of each patient were reviewed retrospectively. Results : The positive rate of blood culture was 72.7%. Staphylococcus aureus was isolated in 38.2% of the patients, making it the most common causative organism of infective endocarditis. It was also the most common organism in both hemodialysis group and non-hemodialysis group. Six patients (10.9%) died while admitted to the hospital and the in-hospital death rate for hemodialysis group was significantly higher. Conclusion : In most parts of the world, S. aureus is increasingly becoming the principal causative organism of infective endocarditis. To our knowledge, this is the first study that shows S. aureus to be the most common causative organism of infective endocarditis in Korea, and that Korea is not except from this global epidemiology.

Two Cases of Infective Endocarditis in Patients with Atopic Dermatitis

( Bok Won Park ),( Yo Sup Shin ),( Eun Byul Cho ),( Eun Joo Park ),( Kwang Ho Kim ),( Kwang Joong Kim ) 대한피부과학회 2019 Annals of Dermatology Vol.31 No.1

Patients with atopic dermatitis have high rates of skin surface colonization of Staphylococcus aureus. At the same time, S. aureus is the major causative organism in infective endocarditis, approximately accounting for 30%∼50% cases of infective endocarditis. A 22-year-old male with severe atopic dermatitis presented with fever and myalgia. He was diagnosed with active infective endocarditis causing multiple cerebral infarction, splenic infarction, and septic shoulder requiring synovectomy. Blood culture proved methicillinsensitive Staphylococcus aureus bacteremia, and the culture from the skin revealed same bacteria. After treated with intravenous antibiotics for 6 weeks, patient was improved. Another 42-year-old female with severe atopic dermatitis who presented with fever and chilling was hospitalized due to acute infective endocarditis. She also had left flank pain and visual disturbance, due to splenic infarction and acute cerebral infarction, respectively. As blood culture revealed methicillin-sensitive Staphylococcus aureus bacteremia, she treated with intravenous antibiotics for 6 weeks. The route of entry of two patients was attributed to the patient eczematous scratching lesion of poorly controlled atopic dermatitis. Infective endocarditis can result in the context of acute deterioration of atopic dermatitis. Dermatologists need to pay attention to this risk and actively manage such conditions in order to decrease the risk of infective endocarditis arising from skin lesions in atopic patients. For these reasons, we herein report two cases of infective endocarditis in patients with atopic dermatitis. (Ann Dermatol 31(1) 70∼74, 2019)

뇌출혈이 합병된 감염성 심내막염 1례

박동건,이재욱,권삼,이동철,강승완 동국대학교 경주대학 1997 東國論集 Vol.16 No.2

감염성심내막염에 의한 신경계 합병증은 색전성 뇌경색, 색전성 뇌출혈, 두개내 패혈성 동맥류, 뇌농양, 뇌막염등 다양한데 항생제 요법의 발달과 판막치환술에도 불구하고 그 빈도는 감소되지 않고 있다. 이 중 두개내 패혈성 동맥류의 파열에 의한 뇌출혈은 사망률이 80%로 치명적일 수 있어 조기 발견 및 적절한 치료가 필요하다. 저자들은 두통, 열감, 근육통 등의 증상으로 내원하여 감염성 심내막염으로 진단받고, 항생제 치료로 임상증세의 호전중에 심한 두통과 전신적 발작이 있은 후 갑자기 발생한 두개내 뇌출혈을 심장초음파 및 뇌 컴퓨터 단층촬영을 통하여 진단, 경험하였기에 문헌고찰과 함께 보고하는 바이다. The complications of infective endocarditis may involve any organ system ie, cardia, neurologic, vascular, dermatologic, and kidney. Extracardiac complications are usually caused by either embolization of vegetations or deposition of immune complexes. Neurologic complications remain a significant problem in bacterial endocarditis and have been reported to occur in up to 20% to 40% of cases of infective endocarditis. The various types of central nervous system disease seen in patients with infective endocarditis are cerebral embolism (with infarction or with intracerebral hemorrhage), intracranial mycotic aneurysm, seizures, brain abscess, meningitis, mental change, psychiatric disorder. Mycotic aneurysms are uncommon but not rare and are an important cause of local or systemic sepsis and acute hemorrhage following aneurysmal rupture. Cerebral mycotic aneurysms have been noted in 2∼10% of cases of bacterial endocarditis and account for 2.5∼6.2% of all intracerebral aneurysms. We have experienced a case of neurologic complication due to infective endocarditis in a 23 year-old female patient, who admitted to our hospital because of fever, chill, headache, myalgia. This case was diagnosed by echocardiography, brain computed tomography. The patient died of sudden intracerebral hemorrhage in the 53th hospital day despite intensive medical treatment. We report one case of intracerebral hemorrhage complicated with infective endocarditis.

황색포도알균이 가장 흔한 원인인 우리나라 4개 대학병원의 감염성심내막염의 특징

서성우,김태형,현민수,추은주,전민혁,문철,송단,김종화,이용관,최종효,전웅,조영신,최문한 대한감염학회 2008 감염과 화학요법 Vol.40 No.6

Background : To evaluate whether Staphylococcus aureus is actually the leading cause of infective endocarditis in Korea, investigation on updated clinical pictures, treatments, and prognosis was performed. This study also aims to describe differences in clinical characteristics of infective endocarditis in patients undergoing maintenance hemodialysis. Materials and Methods : Fifty five patients who were diagnosed with infective endocarditis, using modified Duke criteria, at 4 Soon Chun Hyang University hospitals (located in Seoul, Bucheon, Cheonan and Gumi) from January of 2000 to June of 2007 were enrolled, Patients were separated into two groups; those on hemodialysis and those who were not on hemodialysis (control group). Medical records and laboratory results of each patient were reviewed retrospectively. Results : The positive rate of blood culture was 72.7%. Staphylococcus aureus was isolated in 38.2% of the patients making it the most common causative organism of infective endocarditis. It was also the most common organism in both hemodialysis group and non-hemodialysis group. Six patients (10.9%) died while admitted to the hospital and the in-hospital death rate for hemodialysis group was significantly higher. Conclusion : In most parts of the world, S. aureus is increasingly becoming the principal causative organism of infective endocarditis. To our knowledge, this is the first study that shows S. aureus to be the most common causative organism of infective endocarditis in Korea, and that Korea is not except from this global epidemiology.

Recurrent Infective Endocarditis Associated With Pyogenic Spondylodiskitis

김재훈,김순길,김동찬,박환철,최성일,신진호,이재웅,김정현,임헌길 대한심장학회 2011 Korean Circulation Journal Vol.41 No.3

Infective endocarditis is a life-threatening condition caused by microbial infection of the heart’s endocardial surface. This condition can also be associated with bacterial infections of other organs. We experienced an unusual case of recurrent infective endocarditis associated with pyogenic spondylodiskitis. A 70-year-old man presented with persistent fever and lower back pain visited our hospital. The patient had a past history of recurrent infective endocarditis. He was diagnosed with infective endocarditis again based on clinical symptoms and echocardiographic findings. Magnetic resonance imaging was used to evaluate lower back pain, which showed acute spondylodiskitis on L3 and L4 vertebrae. The patient completely recovered following four weeks of antibiotic therapy.

Q 열에 의한 감염성 심내막염 2예

문수연,최영실,박미연,이정아,정혜숙,정두련,송재훈,백경란,정미경 대한감염학회 2009 Infection and Chemotherapy Vol.41 No.3

Q fever is a zoonosis caused by Coxiella burnetii, presenting as acute and chronic illness and it has been reported worldwide. Acute Q fever is usually asymptomatic or mild and self-limiting, but infective endocarditis is one of the most serious complications of chronic Q fever and can be fatal. Known risk factors for Q fever endocarditis are valvular heart disease, immunocompromised hosts, and pregnancy. There have been some reports on Q fever in Korea but there exists no report on Q fever endocarditis. We have experienced 2 cases of Q fever with underlying valvular heart disease; both patients came to the hospital for evaluation of prolonged fever. Although Q fever and Q fever endocarditis are rare in Korea, Q fever endocarditis should be considered in the differential diagnosis of patient with infective endocarditis when causative microorganism cannot be identified.

녹색사슬알균 균혈증 환자에서 감염성 심내막염의 관련인자와 사망의 예측인자

서영선,김민교,허재형,조오현,김장락,김선주,배인규 대한감염학회 2012 Infection and Chemotherapy Vol.44 No.6

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.

Binding of Streptococcus gordonii to fibrin-platelet Matrix

Lee, Si Young 대한구강생물학회 2003 International Journal of Oral Biology Vol.28 No.2

The pathogenesis of infective endocarditis is a complex process that requires the adherence of bacteria to the valvular surface and the survival of adherent bacteria with the propagation of the endocardial vegetation. Streptococci are one of the most common pathogens associated with the infective endocarditis. Rabbit animal model for infective endocarditis was generally used in in vivo experiments for investigating the microbial pathogenesis in infective endocarditis. However, infective endocarditis animal models are not easy to operate and time consuming. It has been shown that fibrin-platelet matrix prepared in vitro had similar properties as non bacterial thrombotic vegetations. In the present study, in vitro binding experiment model of fibrin-platelet matrix for oral streptococci was established and Streptococcus gordonii, one of the oral streptococcal species, was shown to be able to bind to this in vitro fibrin-platelet matrix.

점액종으로 오인된 우심실에서 발생한 감염성 심내막염 1예

정주영 ( Joo Young Chung ),송수경 ( Soo Kyeong Song ),김유지 ( Yu Ji Kim ),박성철 ( Sung Chul Park ),윤지영 ( Ji Young Yoon ),이현 ( Hyun Lee ),임정호 ( Jung Ho Lim ),조인진 ( In Jin Cho ),정래영 ( Lae Young Jung ),윤하용 ( Ha Yo 전북대학교 의과학연구소 2013 全北醫大論文集 Vol.37 No.1

Infective endocarditis in right-sided heart has rare incidence of 5~12%. And right ventricle is less common site of right-sided heart infective endocarditis. Risk factors for infective endocarditis are drug abuse, previous operation history, any invasive procedures such as sampling, scaling, needling, hemodialysis, and previous infectious history. It rarely happens in a patient without any predisposing factor. Herein we report a case of infective endocarditis in right ventricle without any predisposing factor.

구강질환과 감염성 심내막염

조주영 ( Ju Yeong Jo ),조수진 ( Su Jin Ju ),송희상 ( Hii Sang Song ) 조선대학교 치의학연구원 2014 Oral Biology Research (Oral Biol Res) Vol.38 No.2

Despite significant improvements in medical treatments, infective endocarditis remains a very serious health problem with considerable morbidity and mortality. Indeed, the frequency of severe endocarditis has increased in recent years, particularly in association with antibiotic-resistant pathogens. Accordingly, infective endocarditis constitutes a major challenge for clinicians and a considerable burden for the health-care system. In addition, dental disease has long been associated with increased prevalence of infective endocarditis. Many reports have demonstrated that antibiotics given before a dental procedure can reduce the risk of bacteremia from oral disease. Here, we review recent treatments for prophylaxis of infective endocarditis before dental procedure.