Infective endocarditis is the result of direct infection of the heart valves and ventricular endocardium by a variety of pathogenic microorganisms; the epidemiological situation of infective endocarditis has changed profoundly due to the application of antibacterial drugs, the reduction of rheumatic heart valve disease, the aging of the population, and the widespread development of cardiac surgery. The underlying disease of endocarditis in China has changed from rheumatic heart valve disease to degenerative valve disease, congenital heart disease, intravenous drug crypt, etc. The site of valve infection and pathogenic bacteria also differ, although Streptococcus gramineus still accounts for a large proportion of endocarditis pathogens, but Staphylococcus aureus, Staphylococcus epidermidis, and fungal infections are also on the rise. Drug treatment 1.
Patients with rheumatic heart valve disease, congenital heart disease, and cardiac surgery for more than 12 months are mostly infected with Streptococcus griseus as the causative agent, and high-dose penicillin G (3.2 million units, intravenous infusion, once every 6 hours) +
Amikacin (0.2g, intramuscular injection, every 8 hours ~ 12 hours) or gentamicin (80,000 units, intramuscular injection, every 8 hours), the course of treatment for 4 weeks ~ 6 weeks. 2. Endocarditis occurring within 12 months of cardiac surgery and intravenous drug occultation, with a large proportion of staphylococci, may be treated with benzocillin (2g, intravenous infusion, once every 6 hours) or cefazolin (2g.),
intravenous drip, once every 8 hours) + amikacin (0.2g, intramuscular injection, once every 8 hours~12 hours) or gentamicin (80,000 units, intramuscular injection, once every 8 hours) for 4 weeks to 6 weeks of treatment. Antibacterial therapy is the main treatment measure for sepsis 1, empirical antibacterial therapy Due to the source of infection, the location of infection (inside and outside the hospital), age, etc., drug selection varies, the course of treatment is generally 3 days ~ 5 days after the patient’s symptoms subside; 2, from the urinary tract infection sepsis, bacteria with Escherichia coli as the main, can choose ceftriaxone or levofloxacin treatment; 3, if from the biliary tract infection, gram-negative enteric If the infection comes from the biliary tract and Gram-negative Enterobacteriaceae is the main pathogen, ceftriaxone or ciprofloxacin can be used for treatment; 4.If the infection comes from the skin and Staphylococcus aureus is the main bacterium, ceftriaxone or benzocillin + gentamicin or amikacin can be used for treatment; 5.For young and strong patients with unknown pathogen, ceftriaxone or benzocillin + gentamicin or amikacin can be used for treatment; for old and frail patients, ceftriaxone + gentamicin or amikacin can be used for treatment. For sepsis of unknown etiology, different therapeutic drugs can be used according to different bacteria. 3.General treatment and symptomatic treatment Patients with sepsis can suffer from infectious shock and organ function damage, and anti-shock treatment can be administered according to the situation. 4.Treatment of local infection foci including surgery and drainage.