感染性心内膜炎瓣膜赘生物致病菌分布  

Distribution of pathogenic bacteria in valvular vegetations in patients with infective endocarditis

作　　者：李婷[1] 喻凤[2] 

机构地区：[1]贵州医科大学护理学院,贵州贵阳550001 [2]贵阳中医学院第一附属医院心胸外科,贵州贵阳550001

出　　处：《中国病原生物学杂志》2016年第9期833-836,共4页Journal of Pathogen Biology

基　　金：贵州省科技项目(黔科合J字[2015]1025号)

摘　　要：目的了解感染性心内膜炎患者瓣膜赘生物的致病菌分布及耐药情况,为临床治疗提供指导。方法收集医院心外科感染性心内膜炎患者临床资料,从患者的心脏瓣膜赘生物中分离病原菌,行纯化培养后经全自动微生物鉴定仪鉴定,K-B纸片扩散法进行药敏试验。结果从患者赘生物中共分离69株病原菌,其中革兰阳性菌55株(79.71%),包括草绿色链球菌(30株,占43.48%)、血链球菌(12株,占17.39%)、粪肠球菌(8株,占11.59%)、金黄色葡萄球菌(3株,占4.35%)以及表皮葡萄球菌(2株,占2.90%);革兰阴性菌3株,浅黄金色单胞菌、缺陷短波单胞菌及杀鲑气单胞菌各1株,此外还有11株(15.94%)其他类型致病菌。草绿色链球菌对常用抗菌药物的耐药率分别为红霉素73.33%、克林霉素56.67%、呋喃妥因23.33%、头孢唑林23.33%、青霉素13.33%、氯霉素13.33%、头孢他啶10.00%;血链球菌对常用抗菌药物的耐药率分别为红霉素66.67%、克林霉素33.33%、头孢唑林25.00%、氯霉素25.00%、青霉素16.67%、呋喃妥因16.67%、头孢他啶8.33%;粪肠球菌对常用抗菌药物的耐药率分别为青霉素50.00%、头孢唑林50.00%、红霉素37.50%、呋喃妥因37.50%、氯霉素37.50%、头孢他啶25.00%、克林霉素25.00%;3种致病菌对万古霉素和替考拉宁均未产生耐药性。浅黄金色单胞菌对亚胺培南、左氧氟沙星、阿米卡星均敏感;缺陷短波单胞菌对头孢他啶、头孢呋辛、头孢吡肟均耐药,对亚胺培南、庆大霉素、左氧氟沙星、阿米卡星以及妥布霉素均敏感;除杀鲑气单胞菌对左氧氟沙星的耐药性未检测外,对各检测药物均敏感。结论感染性心内膜炎瓣膜赘生物致病菌以革兰阳性菌为主。感染性心内膜炎革兰阳性菌感染时,万古霉素和替考拉宁可以作为首选药物;革兰阴性菌感染时,有效药物较多,但临床治疗中仍应合理使用抗菌药物,避免耐药性的进一步发展。Objective To study the distribution and drug resistance of pathogenic bacteria in 69 cases of valvular vegetations in patients with infective endocarditis in order to guide clinical treatment. Methods Clinical data on patients with infective endocarditis in Cardiac Surgery at this Hospital were collected,and 69 strains of pathogens were isolated from valvular vegetations in the hearts of patients.Pathogenic bacteria were identified and their drug resistance was analyzed. Results Sixty-nine strains of pathogens were isolated from valvular vegetations found in patients.Most of these pathogens were Gram-positive bacteria（79.71%）,including Streptococcus viridans（43.48%）,Streptococcus sanguis（17.39%）,Enterococcus faecalis（11.59%）,Staphylococcus aureus（4.35%）,and Staphylococcus epidermidis（2.90%）.Gram-negative bacteria included Chryseomonas luteola（1.45%）,Brevundimonas diminuta（1.45%）,Aeromonas salmonicida（1.45%）,and other species（15.94%）.Analysis of the drug resistance of 30 strains of Streptococcus viridans to commonly used antimicrobials indicated that the strains were resistant to erythromycin at a rate of 73.33%,to clindamycin at a rate of 56.67%,to Macrodantin at a rate of 23.33%,to cefazolin at a rate of 23.33%,to penicillin at a rate of 13.33%,to chloramphenicol at a rate of 13.33%,and to ceftazidime at a rate of 10.00%.Analysis of the drug resistance of 12 strains of S.sanguis to commonly used antimicrobials indicated that the strains were resistant to erythromycin at a rate of 66.67%,to clindamycin at a rate of 33.33%,to cefazolin at a rate of 25.00%,to chloramphenicol at a rate of 25.00%,to penicillin at a rate of 16.67%,to Macrodantin at a rate of 16.67%,and to ceftazidime at a rate of8.33%.Analysis of the drug resistance of 8strains of Enterococcus faecalis to commonly used antimicrobials indicated that the strains were resistant to penicillin at a rate of 50.00%,to cefazolin at a rate of 50.00%,to erythromycin at a rate of 37.50%,to Macrodantin at a rate of 37.50%,t

关 键 词：致病菌 瓣膜赘生物 感染性心内膜炎 草绿色链球菌 

分 类 号：R378[医药卫生—病原生物学]