The ClinicianThe ClinicianКлиницист1818-83382412-8775Publishing House ABV Press47110.17650/1818-8338-2021-15-1-4-K651REVIEWОБЗОРInfective endocarditis caused by gram-negative bacteriaИнфекционный эндокардит, вызванный грамотрицательными бактериямиhttps://orcid.org/0000-0002-2083-0437ChipiginaN. S.ЧипигинаН. С.
Russian Federation

Natalia Semyonovna Chipigina

1 Ostrovitianov St., Moscow 117997, Russia

Наталия Семеновна Чипигина

Россия, 117997 Москва, ул. Островитянова, 1

chipigina-natalia56@yandex.ruhttps://orcid.org/0000-0001-7841-8966KarpovaN. Yu.КарповаН. Ю.
Russian Federation

1 Ostrovitianov St., Moscow 117997, Russia

Россия, 117997 Москва, ул. Островитянова, 1

https://orcid.org/0000-0003-4702-3579KashentsevaN. A.КашенцеваН. А.
Russian Federation

1 Ostrovitianov St., Moscow 117997, Russia

Россия, 117997 Москва, ул. Островитянова, 1

https://orcid.org/0000-0001-5675-9487MoritsV.МорицВ.
Russian Federation

1 Ostrovitianov St., Moscow 117997, Russia

Россия, 117997 Москва, ул. Островитянова, 1

Russian National Research Medical University named after N. I. PirogovФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н. И. Пирогова» Минздрава России15102021151-420300503202205032022Copyright ©; 2021, Chipigina N.S., Karpova N.Y., Kashentseva N.A., Morits V.Copyright ©; 2021, Чипигина Н.С., Карпова Н.Ю., Кашенцева Н.А., Мориц В.2021Chipigina N.S., Karpova N.Y., Kashentseva N.A., Morits V.Чипигина Н.С., Карпова Н.Ю., Кашенцева Н.А., Мориц В.https://creativecommons.org/licenses/by/4.0https://klinitsist.abvpress.ru/Klin/article/view/471

Infective endocarditis (IE) caused by Gram-negative bacteria is a rare and insufficiently characterized form of endocarditis. The literature review presents data on the frequency, course, risk factors, diagnosis and treatment of both IE caused by the HACEK microorganisms (Haemophilus spр., Aggregatibacter spp., Cardiobacterium hominis, Eikenella corrodens, Kingella) and other Gram-negative bacteria. Gram-negative bacteria are the cause of 3.6–13.6 % IE cases (HACEK microorganisms in 0.8–3 % of IE cases in adults, non-HACEK in 1.8–3.9 %). Patients with IE caused by the HACEK microorganisms are younger, their disease is not associated with previous in-hospital treatment and is subacute with favorable prognosis (intrahospital mortality is 2–3 %). HACEK microorganisms mostly retain sensitivity to many antibiotics. Risk factors of IE caused by HACEK microorganisms are dental interventions, heart disorders, valve prostheses and other implanted cardiac devices. IE caused by non-HACEK Gram-negative bacteria is more common in elderly with concomitant disorders and usually is acute; intrahospital mortality is 13–36.5 %. Risk factors of IE caused by non-HACEK microorganisms are valve prostheses, electrical pacemakers, venous and central catheters, recent in-hospital treatment, Gram-negative bacteremia, decreased immunity, drug abuse, urinary infection, alcoholism, cirrhosis of the liver, removed spleen, consequences of dog and cat bites, working with the soil. Among Gram-negative non-HACEK bacteria causing IE, 28 % have multi-drug resistance (MDR / XDR) against antibiotics. Therefore, Gram-negative bacteria rarely cause IE but during selection of empiric therapy in patients with IE with corresponding risk factors, probability of Gram-negative causative microorganisms in IE etiology should be taken into account.

Инфекционный эндокардит (ИЭ), вызванный грамотрицательными микроорганизмами, – редкая и недостаточно охарактеризованная форма эндокардита. В обзоре литературы представлены данные о частоте, течении, факторах риска, диагностике и лечении как И Э, вызванного микроорганизмами группы НАСЕК (Haemophilus spр., Aggregatibacter spp., Cardiobacterium hominis, Eikenella corrodens, Kingella), так и И Э, обусловленного другими грамотрицательными бактериями. Грамотрицательные возбудители вызывают 3,6–13,6 % случаев ИЭ (микроорганизмы группы НАСЕК – 0,8–3 % случаев ИЭ у взрослых, и грамотрицательные возбудители не группы НАСЕК – 1,8–3,9 %). Больные ИЭ, вызванным возбудителями группы НАСЕК , моложе, заболевание не связано с предшествующим лечением в стационаре, протекает подостро и имеет благоприятный прогноз (внутрибольничная летальность – 2–3 %). Возбудители группы НАСЕК в целом сохраняют достаточную чувствительность ко многим антибиотикам. Факторы риска ИЭ, вызванного возбудителями группы НАСЕК : стоматологические вмешательства, пороки сердца, протезы клапанов или другие имплантированные внутрисердечные устройства. ИЭ, вызванный грамотрицательными бактериями не группы НАСЕК , чаще возникает у людей старшего возраста с сопутствующими заболеваниями, протекает обычно остро, внутрибольничная летальность составляет 13–36,5 %. Факторы риска ИЭ, вызванного грамотрицательными возбудителями не НАСЕК группы: протезы клапанов, электрокардиостимуляторы, катетеры венозные и центральные, недавнее лечение в стационаре, грамотрицательная бактериемия, нарушения иммунитета, наркомания, мочевая инфекция, алкоголизм, цирроз печени, удаленная селезенка, связь с укусами собак и кошек, работой с почвой. 28 % грамотрицательных возбудителей ИЭ не НАСЕК группы мультирезистентны (MDR / XDR) к антибиотикам. Таким образом, грамотрицательные бактерии редко вызывают ИЭ, но при выборе эмпирической терапии ИЭ у больных с соответствующими факторами риска необходимо учитывать вероятность грамотрицательных возбудителей в этиологии ИЭ.

infective endocarditisHACEK endocarditisGram-negative infective endocarditisbacteremiaHACEK group bacteriaprosthetic valve endocarditisHaemophilus spр.Aggregatibacter spp.Cardiobacterium hominisEikenella corrodensKingellaPseudomonas aeruginosaSerratia marcescensantibacterial therapymulti-resistanceинфекционный эндокардитинфекционный эндокардитвызванный бактериями HACEK группыинфекционный эндокардитвызванный грамотрицательными бактериямибактериемиябактерии группы HACEKэндокардит протезированного клапанаHaemophilus spр.Aggregatibacter spp.Cardiobacterium hominisEikenella corrodensKingellaPseudomonas aeruginosaSerratia marcescensантибактериальная терапиямультирезистентностьHolland T.L., Baddour L.M., Bayer A.S. et al. Infective endocarditis. Nat Rev Dis Primers 2016;2:16059. DOI: 10.1038/nrdp.2016.59.Murdoch D.R., Corey G.R., Hoen B. et al. 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