russjcardiolРоссийский кардиологический журналRussian Journal of Cardiology1560-40712618-7620«SILICEA-POLIGRAF» LLC10.15829/1560-4071-2016-1-80-89russjcardiol-639Research ArticleОБЗОРЫ ЛИТЕРАТУРЫREVIEWИНФЕКЦИОННЫЙ ЭНДОКАРДИТ У ПОЖИЛЫХ: ОТ ЭТИОЛОГИЧЕСКИХ ОСОБЕННОСТЕЙ ДО ЛЕЧЕНИЯ И ПРОФИЛАКТИКИINFECTIVE ENDOCARDITIS IN ELDERLY: FROM ETIOLOGY TO TREATMENT AND PREVENTIONВатутинН. Т.VatutinN. T.

д. м.н., профессор, зав. кафедрой госпитальной терапии

ТарадинГ. Г.TaradinG. G.

к. м.н., доцент кафедры госпитальной терапии

taradin@inbox.ruЧаусЕ. А.TchausE. A.

студентка 6-го курса, 2-го медицинского факультета

СмирноваА. С.SmirnovaA. S.

к. м.н., ассистент кафедры госпитальной терапии

Донецкий национальный медицинский университет им. М . Горького, Донецк Институт неотложной и восстановительной хирургии им. В. К . Гусака, Донецк, ДНРРоссияM. Gorky Donetsk National Medical University, Donetsk V. K. Gusak Institute of Urgent and Reconstruction Surgery, Donetsk, DFR.Russian FederationДонецкий национальный медицинский университет им. М . Горького, ДонецкРоссияM. Gorky Donetsk National Medical University, DonetskRussian Federation201628012016018089Copyright © Ватутин Н.Т., Тарадин Г.Г., Чаус Е.А., Смирнова А.С., 20162016Ватутин Н.Т., Тарадин Г.Г., Чаус Е.А., Смирнова А.С.Vatutin N.T., Taradin G.G., Tchaus E.A., Smirnova A.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://russjcardiol.elpub.ru/jour/article/view/639

В представленном обзоре отмечено изменение эпидемиологического профиля инфекционного эндокардита (ИЭ) с увеличением заболеваемости в пожилом возрасте. Обсуждаются факторы риска ИЭ, включая перенесенные ранее заболевания эндокарда различного генеза, имплантацию искусственного клапана, проведение различных лечебных и диагностических инвазивных процедур и особенно кардиохирургических вмешательств. Среди факторов риска, предрасполагающих к инфекционному поражению эндокарда у пожилых лиц, отмечены кальцификация клапанов, возрастные изменения эндокарда, наличие сахарного диабета, воспалительных заболеваний желудочно-кишечного и урогенитального тракта. Приведены особенности этиологического спектра возбудителей ИЭ, характеризующиеся увеличением частоты случаев, вызванных S. bovis, энтерококками, коагулазонегативными стафилококками по сравнению с более молодыми группами больных. В обзоре особое внимание уделяется микробиологической диагностике, как одному из больших критериев в диагностике ИЭ. Подходы к лечению заболевания приведены с учетом общих принципов, выбора эмпирической терапии и назначения соответствующих антибактериальных препаратов после получения результатов бактериологического исследования гемокультуры. Принципы лечения пожилых больных с ИЭ основаны на рекомендациях экспертов Европейского Общества Кардиологов и Американской Ассоциации Сердца, опубликованных в 2015г. Подчеркивается важность профилактики инфекционного поражения эндокарда у лиц высокого риска при применении манипуляций высокого риска, а также соблюдения общих гигиенических мер и санитарных норм.

The review reflects the changes of epidemiological profile of infective endocarditis (IE) with an increase of prevalence in elderly. The risk factors are discussed, including anamnesis of various endocardium diseases, artificial valves implantation, different treatments or diagnostic procedures and especially cardiosurgical interventions. Among risk factors, predisposing to the infectious involvement of endocardium in elderly, are calcification of leaflets, age-related changes, diabetes, inflammatory diseases of gastrointestinal and urogenital tracts. The specifics of etiological spectrum of IE microbes is presented, with increased prevalence of S. bovis endocarditis, enterococcus, coagulase-negative staphylococci, in comparison with younger patients. The review focuses on microbiological diagnostics as one of the main criteria of IE. Approaches to treatment of the disease are shown with general principles, selection of empirical therapy and prescription of relevantantibacterial drugs after obtaining of bacteriological results of hemoculture. The principles of treatment of the elderly are based upon expert Guidelines of European Society of Cardiology and American Heart Association, published in 2015. The importance underlined of prevention in higher risk groups and procedures of high risk, as of following general hygienic and sanitation norms.

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The authors declare that there are no conflicts of interest present.