목 적 : 감염성 심내막염은 최근들어 노인 연령층의 증가, 퇴행성 판막질환의 증가, 인공판막치환술의 증가, 병원내 시술의 증가 등과 같은 여러가지 환경적인 여건의 변화로 인해 역학적, 임상적 모습도 달라지고 있다.재료 및 방법 : 1995-2003년까지 삼성서울병원에 입원하여 감염성 심내막염으로 진단된 환자 152명을 대상으로 의무기록의 후향적 조사를 시행하였다. 선정된 환자들을 1995-1999년 사이에 진단된 군을 I군, 2000-2003년에 진단된 군을 II군으로 나누었고, 두 군간의 역학적인 특징, 위험인자, 원인균, 임상양상과 합병증 등을 비교하였다. 결 과 : 전체 환자 152명중 I군은 64명, II군은 88명이었다. 평균연령은 46±19세였고 두 군간의 차이는 없었다(P=0.421). 혈액배양 결과 균이 동정된 경우는 총78.3% 이었다. Viridans streptococcus (39.4%)가 가장 흔한 균주였고, Staphylococcus aureus (32.8%)도 높은 빈도를 보였다. 그 외 Staphylococcus epidermidis (8.4%), Enterococcus (7.6%), 그람 음성균(5.9%) 순이었다. 혈액투석이나 정맥내 도관삽입과 같은 의학적 시술은 II군에서 빈도가 높았고, 이에 따라 병원내 감염의 빈도도 II군에서 유의하게 높았다(3.1% : 21.6%, P=0.001). 전체 심내막염 환자의 기여사망률은 9.2%였으며, 지역사회에서 발생한 심내막염에 비해 병원내 감염의 사망률이 유의하게 높았다(6.9% : 23.8%, P=0.013). 심내막염의 치료중 수술을 시행한 군의 사망률은 시행하지 않은 군보다 낮게 나타났다(1.2% : 18.3%, P=0.000) 결 론:최근 여러 가지 환경적인 여건의 변화로 인해 심내막염의 역학적, 임상적 소견이 조금씩 변화하고 있으며, 심내막염 환자를 진료하는데 있어서 이러한 변화를 인지하여야 하겠다.

Background : Epidemiologic and clinical features of infective endocarditis have been changing with increasing longevity, new predisposing factors, and increase in nosocomial infections. Materials and Methods : All consecutive cases of infective endocarditis from 1995 to 2003 at the Samsung Medical Center, Seoul, Korea, were evaluated. Epidemiologic and clinical characteristics of patients were analysed by review of medical records. Changing features of endocarditis were compared between Group I (1995-1999) and Group II (2000-2003). Results : Total number of cases was 152; 64 cases in Group I and 88 cases in Group II. Mean age was 46±19 years with no difference between two groups. Blood cultures were positive in 119 of 152 cases(78.3%). Streptococcus viridans (39.4%) and Staphylococcus aureus (32.8%) were the most common pathogens of infective endocarditis followed by Staphylococcus epidermidis (8.4%), Enterococcus (7.6%), and Gram negative organism (5.9%). Pathogen distribution was not different between two groups. Medical procedures, such as hemodialysis (0% : 12.5%, P=0.003) and intrvenous catheter insertion (1.6% : 15.9%, P=0.003), were more frequently performed in Group II and the incidence of nosocomial endocarditis was significantly higher in Group II (3.1% versus 21.6%, P=0.001). Surgical treatment was performed in 53.3% of cases. The overall mortality rate in patients with infective endocarditis was 9.2%. The mortality rate among patients with community-acquired endocarditis was 6.9% and that among nosocomial endocarditis was 23.8%. Conclusion : Epidemiological and clinical features of infective endocarditis over the past years have been changing, and clinicians should be aware of these differences when treating patients with endocarditis.

Background : Epidemiologic and clinical features of infective endocarditis have been changing with increasing longevity, new predisposing factors, and increase in nosocomial infections. Materials and Methods : All consecutive cases of infective endocarditis from 1995 to 2003 at the Samsung Medical Center, Seoul, Korea, were evaluated. Epidemiologic and clinical characteristics of patients were analysed by review of medical records. Changing features of endocarditis were compared between Group I (1995-1999) and Group II (2000-2003). Results : Total number of cases was 152; 64 cases in Group I and 88 cases in Group II. Mean age was 46±19 years with no difference between two groups. Blood cultures were positive in 119 of 152 cases(78.3%). Streptococcus viridans (39.4%) and Staphylococcus aureus (32.8%) were the most common pathogens of infective endocarditis followed by Staphylococcus epidermidis (8.4%), Enterococcus (7.6%), and Gram negative organism (5.9%). Pathogen distribution was not different between two groups. Medical procedures, such as hemodialysis (0% : 12.5%, P=0.003) and intrvenous catheter insertion (1.6% : 15.9%, P=0.003), were more frequently performed in Group II and the incidence of nosocomial endocarditis was significantly higher in Group II (3.1% versus 21.6%, P=0.001). Surgical treatment was performed in 53.3% of cases. The overall mortality rate in patients with infective endocarditis was 9.2%. The mortality rate among patients with community-acquired endocarditis was 6.9% and that among nosocomial endocarditis was 23.8%. Conclusion : Epidemiological and clinical features of infective endocarditis over the past years have been changing, and clinicians should be aware of these differences when treating patients with endocarditis.

Endocarditis, Clinical manifestation