Новые достижения в лечении инфекционного эндокардита и инфекционного кардиоваскулита

Клиническая Микробиология и Антимикробная Химиотерапия. 2000; 2(3):32-47

​ Гутщик Э.
инфекционный эндокардит терапия бактериальная инфекция кардиоваскулит
Раздел
Болезни и возбудители
Тип
Журнальная статья
Публикация
Клиническая Микробиология и Антимикробная Химиотерапия. 2000; 2(3):32-47

Аннотация

Переведена и печатается с согласия автора и редакции журнала «Interanational Journal of Antimicrobial Agents» 1999; 13:79-92.

В последние 100 лет значительно изменилось естественное течение инфекционного эндокардита. Это обстоятельство обусловлено изменениями демографических факторов и частоты проявлений так называемых диагностических симптомов. Наряду с указанными изменениями и улучшением диагностики врачи сталкиваются с новыми трудностями, прежде всего с необходимостью более точного определения кардиоваскулярных инфекций и уровня заболеваемости. Нозокомиальные эндокардиты, их диагностика и лечение приобретают все большее значение в связи с оперативными вмешательствами на клапанах сердца, использованием искусственных водителей ритма и широкого спектра других искусственных материалов. Благодаря новым технологическим достижениям, включающим новые типы искусственных клапанов и применение гомотрансплантантов или проведение операции Росса (Ross), представляется возможность оптимального решения в каждом конкретном случае. Антибиотикотерапия инфекционного эндокардита основана в большей мере на нашем понимании патогенеза инфекции и эффективности антибиотиков, продемонстрированной в экспериментальных моделях эндокардита у животных. Однако рекомендации по моно- и комбинированной терапии или режимах дозирования антибиотиков являются в основном мнениями экспертов, не всегда подкрепленными экспериментальными или клиническими доказательствами. Типичный пример этому – рекомендация введения суточной дозы гентамицина в два приема при лечении стрептококкового эндокардита. Тем не менее позиция автора заключается в поддержке идеи о необходимости и целесообразности разработки несложных, доступных при работе диагностических и лечебных режимов, что будет способствовать более широкому внедрению их в практику.

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