의료환경 변화에 따른 감염성 심내막염의 양상 변화

Abstract

Background: In July 2000, there was a dramatic change in Korean health care system with the medical reform, the separation system of pharmacies and prescriptions. Before then, patients could easily get antibiotics without doctors’ prescriptions. Since the symptoms and signs of infective endocarditis are very nonspecific, prior self treatment with antibiotics before admission was common. This study was performed to determine the changing trends of infective endocarditis according to the change in health care system.

Methods: One hundred eighty eight patients from 8 different medical institutions were included. Medical records were reviewed retrospectively for each patient who was diagnosed as infective endocarditis by Modified Duke criteria. Patients were separated into two different groups (Group I : patients diagnosed before July 2000, Group II : patients diagnosed after November 2000). Clinical characteristics, blood culture positivity, and in-hospital mortality were compared.

Results: There was no difference in clinical manifestation between two groups other than malaise. Blood culture positivity was 57.4% in group I and 71.1% in group II. Blood culture positivity was significantly higher in group II (p=0.038). In-hospital mortality tends to be lower in group II, which was 22.3% in group I and 12.9% in group II (p=0.066). The relationship between higher blood culture positivity and lower in-hospital mortality couldn’t be clarified.

Conclusion: There was an increase in blood culture positivity and a tendency to decrease in in-hospital mortality after July, 2000, possibly due to health care reform. This, to my knowledge, is the first effort to investigate the changing trends of an actual clinical disease according to the change in health care system.