cardioКардиологияKardiologiia0022-90402412-5660Kardiomag10.18087/cardio.2023.1.n2307cardio-2307Research ArticleРЕДАКЦИОННАЯ СТАТЬЯEDITORIALГлобальные и национальные тренды эволюции инфекционного эндокардитаGlobal and national trends in the evolution of infective endocarditishttps://orcid.org/0000-0002-5873-1768КобалаваЖ. Д.KobalavaZh. D.

член-корреспондент РАН, профессор, доктор медицинских наук, заведующая кафедрой внутренних болезней с курсом кардиологии и функциональной диагностики имени В.С. Моисеева, Медицинский институт, Российский Университет Дружбы Народов (ФГАОУ ВО РУДН)SPIN-код: 9828-5409

Москва, Россия

correspondent member of Russian academy of science, M.D., PhD, professor, chef of the department of the internal diseases with the course in cardiology and functional diagnostics named after V.S. Moiseev, FGAOU VO People`s Friendship University of Russia (RUDN University)

SPIN: 9828-5409

Moscow, Russia

zkobalava@mail.ruhttps://orcid.org/0000-0002-9643-5089КотоваЕ. О.KotovaE. O.

к.м.н., доцент кафедры внутренних болезней с курсом кардиологии и функциональной диагностики имени В.С. Моисеева, Медицинский институт, Российский Университет Дружбы Народов (ФГАОУ ВО РУДН). 

SPIN-код: 6397-6480

Москва, Россия

PhD, associate professor of the department of internal diseases with the course in cardiology and functional diagnostics named after V.S. Moiseev, FGAOU VO People`s Friendship University of Russia (RUDN University)

SPIN: 6397-6480

Moscow, Russia

kotova_eo@pfur.ruФГАОУ ВО «Российский университет дружбы народов»; ГБУЗ «Городская клиническая больница им. В.В. Виноградова»РоссияRussian University of Peoples’ Friendship; Vinogradov Municipal Clinical HospitalRussian Federation202331012023631311Copyright © Kardiomag, 20232023KardiomagKardiomaghttps://cardio.elpub.ru/jour/about/submissions#copyrightNoticehttps://cardio.elpub.ru/jour/article/view/2307

За последние 20 лет произошли существенные изменения всех аспектов инфекционного эндокардита (ИЭ) – эволюция факторов риска, модернизация методов диагностики, лечебных и профилактических подходов. Глобальные тенденции характеризуются ростом заболеваемости ИЭ среди лиц старше 65 лет и употребляющих внутривенные психоактивные препараты. Эпидемиологический тренд представлен уменьшением роли хронической ревматической болезни сердца и врожденных пороков сердца, увеличением доли ИЭ, ассоциированного с оказанием медицинской помощи, протезированием клапанов и установкой внутрисердечных устройств, а также ростом вклада Staphylococcus spp. и Enterococcus spp. в этиологии ИЭ. Важное значение приобретают дополнительные визуализирующие методы (позитронно-эмиссионная томография с флудезоксиглюкозой (18F-ФДГ ПЭТ/КТ), однофотонная эмиссионная компьютерная томография (ОФЭКТ/КТ) с меченными лейкоцитами) и модернизация алгоритма этиологической диагностики для определения истинного возбудителя (иммунохимические, полимеразная цепная реакция, секвенирование). Пандемия COVID-19 также внесла негативный вклад в эпидемиологию ИЭ. Обозначились новые перспективы лечения: бактериофаги, лизины, пероральные режимы антибактериальной терапии, малоинвазивные хирургические стратегии (чрескожная механическая аспирация), эндоваскулярная механическая эмболэктомия. Отмечается низкая приверженность врачей к клиническим рекомендациям (КР), что влияет на высокую частоту неблагоприятных исходов ИЭ, в то время как простое соблюдение КР с повышением роли хирургического лечения увеличивает выживаемость в два раза. Решающую роль для благоприятного прогноза динамично меняющегося ИЭ имеет методичное следование КР, своевременная профилактика и внедрение в практику «Команды эндокардита». В статье представлены собственные данные, подтверждающие тренды эволюции современного ИЭ.

 

For the recent 20 years, substantial changes have occurred in all aspects of infectious endocarditis (IE), the evolution of risk factors, modernization of diagnostic methods, therapeutic and preventive approaches. The global trends are characterized by increased IE morbidity among people older than 65 who use intravenous psychoactive drugs. The epidemiological trend is represented by reduced roles of chronic rheumatic heart disease and congenital heart defects, increased proportion of IE associated with medical care, valve replacement, installation of intracardiac devices, and increased contribution of Staphylococcus spp. and Enterococcus spp. to the IE etiology. Additional visualization methods (fluorodeoxyglucose positron emission tomography with 18F-fludesoxyglucose (18F-FDG PET-CT), labeled white blood cell single-photon emission computed tomography (SPECT), and modernization of the etiological diagnostic algorithm for determining the true pathogen (immunochemistry, polymerase chain reaction, sequencing) also become increasingly important. The COVID-19 pandemic has also adversely contributed to the IE epidemiology. New prospects of treatment have emerged, such as bacteriophages, lysins, oral antibacterial therapy, minimally invasive surgical strategies (percutaneous mechanical aspiration), endovascular mechanical embolectomy. The physicians’ compliance with clinical guidelines (CG) is low, which contributes to the high rate of adverse outcomes of IE, while simple adherence to the CG together with more frequent use of surgical treatment doubles survival. Systematic adherence to CG, timely prevention and implementation of the Endocarditis Team into practice play the decisive role in a favorable prognosis of dynamically changing IE. This article presents the authors’ own data that confirm the evolutionary trends of current IE.

 

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