小儿先天性心脏病并发感染性心内膜炎的病原菌分布及耐药性分析  

Pathogens distribution and drug resistance of infective endocarditis in children with congenital heart disease

作　　者：彭静[1] 尹薇[1] 王瑞耕[1] 刘玲[1] 孙东明[1] 夏琨[1] 龙元[1] 

机构地区：[1]武汉市妇女儿童医疗保健中心心血管风湿免疫科,武汉430016

出　　处：《临床心血管病杂志》2016年第5期497-499,共3页Journal of Clinical Cardiology

摘　　要：目的:通过分析先天性心脏病并发感染性心内膜炎患儿病原菌的分布及耐药性特点,为临床诊疗及合理选用抗菌药物提供依据。方法:回顾性分析先天性心脏病并发感染性心内膜炎76例患儿的血培养资料,统计其病原菌种类及药敏试验结果。结果:76例患儿中血培养阳性28例(36.8%),病原菌以革兰氏阳性球菌占多数,草绿色链球菌仍是最常见的致病菌(46.8%)。草绿色链球菌对青霉素、头孢霉素的耐药率在10%左右,葡萄球菌对青霉素G的耐药率达100%,其中凝固酶阴性葡萄球菌表现出多重耐药性,对苯唑西林、头孢呋辛、头孢唑啉及复方新诺明均显示出较高的耐药率(85%左右)。草绿色链球菌、凝固酶阴性葡萄球菌及金黄色葡萄球菌对万古霉素、利奈唑胺和替考拉宁的耐药率和均为0%。革兰氏阴性杆菌药敏分析显示其对青霉素、头孢菌素类均有不同程度的耐药。结论:先天性心脏病合并感染性心内膜炎病原菌菌种以革兰氏阳性球菌占多数,其中以草绿色链球菌占首位。革兰氏阳性球菌均对万古霉素敏感,除草绿色链球菌外,对青霉素普遍呈现耐药。凝固酶阴性葡萄球菌耐药率显著高于金黄色葡萄球菌,表现出多重耐药性。Objective：To investigate the distribution and drug resistance of pathogens in blood culture of infective endocarditis in children with congenital heart disease formprovingthe antimicrobial therapy.Method：Seventysix cases of children with infective endocarditis and congenital heart disease were included.The pathogens distribution and drug resistance in blood culture was analysed.Result：Twenty-eight cases had positive blood culture and the positive blood culture rate was 36.8%.Streptococcus viridans（n=15,46.8%）was the most common pathogen.The resistance rate of streptococcus viridans to penicillin and ceftriaxone was 10.0%,the resistance rate of staphylococcus to penicillin was 100%,especially coagulase negative staphylococcus has higher resistant rate to oxacillin,cefuroxime,cefazolin and cotrimoxazole（85%）.And the resistance rate of streptococcus viridans,coagulase negative staphylococcus and staphylococcus aureus to vancomycin,teicoplanin and linezolidand mediation were 0%.Conclusion：The pathogen in children with infective endocarditis and congenital heart disease appears complex.Streptococcus viridans is still in the first place（46.8%）,the drug resistance of coagulase negative staphylococcus are higher than staphylococcus aureus.

关 键 词：感染性心内膜炎 先天性心脏病 病原菌 耐药性 

分 类 号：R542.4[医药卫生—心血管疾病]