Глобальные и национальные тренды эволюции инфекционного эндокардита

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.

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