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我院162例感染性心内膜炎患者的临床和病原学特征分析
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| 篇名： | 我院162例感染性心内膜炎患者的临床和病原学特征分析 |
| TITLE： | |
| 摘要： | 目的：为临床合理使用抗菌药物提供参考。方法：选取2014年1月－2016年6月我院感染性心内膜炎（IE）住院患者162例，对其基本情况，赘生物分布情况，临床表现及检查指标，标本类型、病原菌构成及耐药情况，治疗情况与结局等临床和病原学资料进行回顾性分析。结果：162例IE患者的男女比例为1.9 ∶ 1，年龄多集中在41～60岁，有146例患者合并心脏基础疾病（占90.1％）。有145例患者为赘生物阳性，且多累及左心系统，以主动脉瓣赘生物最为常见（59例，占40.7％）。出现发热的患者有130例，其中白细胞计数、中性粒细胞百分比升高的分别有66、104例，红细胞计数、血红蛋白降低的分别有69、100例，丙氨酸转氨酶、天冬氨酸转氨酶、血肌酐水平升高的分别22、45、16例。162例IE患者共送检血液标本696份，阳性标本282份（阳性率为40.5％）；有78例患者的血培养结果呈阳性（占48.1％）。共检出病原菌88株，含革兰氏阳性菌84株（占95.5％，以链球菌属细菌为主）和革兰氏阴性菌4株（占4.5％）。链球菌属细菌对青霉素的耐药率为30.4％；12株葡萄球菌属细菌均对青霉素耐药，对苯唑西林的耐药率为50.0％；肠球菌属细菌对青霉素、苯唑西林、阿米卡星耐药；但上述细菌对万古霉素、替考拉宁、利奈唑胺敏感，耐药率均为0。162例IE患者中，有140例患者行心脏外科手术清除赘生物（占86.4％）；158例患者治愈或病情好转，2例死亡，2例自行出院。结论：我院IE患者以男性居多，且多合并有心脏基础疾病；多数患者可见心脏赘生物，以左心赘生物更为常见；发热患者居多，并伴有贫血、肝肾功能损害等症状；引发IE的病原菌以革兰氏阳性菌为主，链球菌属仍是最常见的菌种，耐药情况不容乐观。临床应结合当地病原学资料经验性选择抗菌药物，并根据药敏试验结果及时调整用药方案，以确保抗感染治疗的有效性和安全性。 |
| ABSTRACT： | OBJECTIVE： To provide reference for rational use of antibiotics in clinic. METHODS： A total of 162 inpatients with infective endocarditis （IE） selected from our hospital during Jan. 2014-Jun. 2016 were analyzed retrospectively in respects of general information of patients， distribution of neoplasm， clinical manifestations， examination indexes， sample type， pathogenic composition， drug resistance， treatment and outcome. RESULTS： Among 162 IE patients， the ratio of male to female was 1.9 ∶ 1， and the age of patients were mainly 41-60 years old. Totally 146 patients suffered from cardiac basic disease （90.1％）. One hundred and forty-five patients suffered from positive neoplasm， which mainly involved left ventricular system. Aortic valve neoplasm was the most common （59 cases， 40.7％）. One hundred and thirty patients suffered from fever. Among them， white blood cell count of 66 cases and neutrophil percentage of 104 cases were increased， while red blood cell count of 69 cases and hemoglobin of 100 cases were decreased. ALT of 22 cases， AST of 45 cases and serum creatinine of 16 cases were increased. Among 162 IE patients， 696 blood samples and 282 positive samples were detected （positive rate of 40.5％）. Blood culture of 78 patients were positive （48.1％）. Eighty-eight strains of pathogens were detected， including 84 strains of Gram-positive bacteria （95.5％， mainly being Streptococcus） and 4 strains of Gram-negative bacteria （4.5％）. Resistance rate of Streptococcus to penicillin was 30.4％. Twelve strains of Staphylococcus were resistant to penicillin， and resistance rates of them to oxacillin were 50.0％. Enterococcus was resistant to penicillin， oxacillin and amikacin. Above bacteria were all sensitive to vancomycin， teicoplanin and linezolid， with resistant rate of 0. Among 162 IE patients， 140 patients underwent cardiac surgery to clear neoplasm （86.4％）， 158 patients were cured or recovered， 2 cases died and 2 cases were discharged from hospital voluntarily. CONCLUSIONS： In our hospital， IE patients are mainly male and suffered from cardiac basic disease. Most of the patients have cardiac neoplasm， which were mainly left cardiac neoplasm. Fever patients are the majority， accompanied by anemia， liver and kidney dysfunction and other symptoms. The pathogenic bacteria causing IE are mainly Gram-positive bacteria； Streptococcus is still the most common bacteria， and drug resistance is not optimistic. Antibiotics should be selected according to local etiological data， and medication plan should be adjusted in time according to the results of drug sensitivity test so as to guarantee the effectiveness and safety of anti-infection treatment. |
| 期刊： | 2017年第28卷第29期 |
| 作者： | 叶飞，张蓉，周世文 |
| AUTHORS： | YE Fei，ZHANG Rong，ZHOU Shiwen |
| 关键字： | 感染性心内膜炎；病原菌；抗菌药物；耐药性；临床特征；病原学特征 |
| KEYWORDS： | Infective endocarditis；Pathogens；Antibiotics； Drug resistance； Clinical characteristics； Pathogenic characteristics |
| 阅读数： | 331 次 |
| 本月下载数： | 14 次 |
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