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Hjartaþelsbólga á Íslandi 2000-2009. Nýgengi, orsakir og afdrif

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Authors
Elín Björk Tryggvadóttir
Uggi Þórður Agnarsson
Jón Þór Sverrisson
Sigurður B. Þorsteinsson
Jón Vilberg Högnason
Guðmundur Þorgeirsson
Issue Date
2012-01-01

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Other Titles
Endocarditis in Iceland 2000-2009, a national survey incidence, microbiology and prognosis
Citation
Læknablaðið 2012, 98(1):25-30
Abstract
Tilgangur: Þjóðfélagsbreytingar síðustu áratuga, aukið langlífi, lægri tíðni gigtsóttar og aukinn fjöldi sjúklinga með gervilokur hefur breytt sjúkdómsmynd hjartaþelsbólgu umtalsvert. Tilgangur rannsóknarinnar var að kanna nýgengi, orsakir og afdrif sjúklinga með sjúkdóminn á Íslandi og meta breytingar sem orðið hafa frá 1975-1985. Efniviður og aðferðir: Rannsóknin er afturskyggn og nær til allra sjúklinga sem greindust með hjartaþelsbólgu á Íslandi árin 2000-2009. Upplýsingar fengust úr sjúkraskrám. Niðurstöður: Á tímabilinu greindust 88 tilfelli hjartaþelsbólgu (71% karlar, meðalaldur 59 ár) og er nýgengi sjúkdómsins 2,97/100 þúsund íbúa/ár. Í 40% tilfella var sýking í míturloku, í 31% í ósæðarloku og í 10% í þríblöðkuloku. Í 22% tilfella var sýking í gerviloku. Algengustu bakteríurnar voru streptókokkar (33%), stafýlókokkar (25%) og enterókokkar (16%) en ræktun var neikvæð í 9 tilfellum (10%). Gripið var til lokuaðgerðar í 16 tilfellum (18%). Tólf sjúklingar létust í legu (14%) og þrír greindust við krufningu. Eins árs lifun reyndist vera 77% og 5 ára lifun 56,6%. Ályktun: Nýgengi hjartaþelsbólgu er lágt hér á landi samanborið við erlendar rannsóknir. Frá árunum 1976-1985 hefur hlutfall sprautufíkla með sjúkdóminn aukist og sýkingum í gervilokum fjölgað. Bakteríuflóran hefur lítið breyst, sýkingar af völdum streptókokka voru algengastar, gagnstætt því sem sést í öðrum þróuðum löndum þar sem S. aureus er orðinn algengari. Lokuaðgerðum er sjaldnar beitt hér en víða erlendis. Dánartíðni reyndist lægri en á árunum 1976-1985 og eins árs lífshorfur góðar samanborið við erlendar rannsóknir.
INTRODUCTION: The objective of this study was to analyze the incidence, clinical features, microbiology and prognosis of patients with infective endocarditis (IE) in Iceland, and to compare the results with a previous study made in Iceland 1976-85. MATERIAL AND METHODS: A retrospective study including all patients diagnosed with IE in Iceland 2000-2009. Information was obtained from medical records. RESULTS: A total of 88 cases (71% men, mean age 59 years) were diagnosed and the incidence of IE was calculated 2.97/100.000 person-years. The mitral valve was infected in 35 patients (40%), aortic in 27 (31%) and tricuspid in 9 (10%). In 19 cases a prosthetic valve was infected (22%), one early (<<60 days from procedure) and 18 late. Sixteen patients were intravenous drug users. The most common causative organisms were streptococcus (33%), staphylococcus (25%) and enterococcus (16%). Surgical intervention was performed in 16 cases (18%). One and five year survival was 77% and 57% respectively. CONCLUSION: The incidence of IE in Iceland is still low compared to other countries. The clinical profile of the disease has changed since 1976-85, patients with prosthetic heart valves and intravenous drug users were more prominent than before. The microbiological spectrum has not changed much, streptococcus is still the most common pathogen, contrary to what is seen in other industrial countries where S. aureus is more frequent. Death rate is lower than before and one year survival good compared to other reports.
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