心脏直视术患者术后感染心内膜炎病原菌及耐药性研究  

Distribution and drug resistance of pathogens isolated from patients with infective endocarditis after cardiac surgery

作　　者：杨志远[1] 裴学良[1] 谢周良[1] 权晓强[1] 冯德广[1] YANG Zhi-yuan;PEI Xue-liang;XIE Zhou-liang;QUAN Xiao-qiang;FENG De-guang(Henan Province People＇s Hospital,Zhengzhou,Henan 450003,China)

机构地区：[1]河南省人民医院心血管外科二病区,河南郑州450003

出　　处：《中华医院感染学杂志》2018年第20期3104-3106,3110,共4页Chinese Journal of Nosocomiology

基　　金：河南省医学科技攻关计划基金资助项目(201506283)

摘　　要：目的调查心脏直视术患者感染心内膜炎病原菌和耐药情况及相关因素。方法选取2015年12月-2016年10月医院收治的心脏直视术患者288例为研究对象,对患者的医院感染情况进行统计,分析感染病原菌及耐药情况,结合患者的临床资料归纳心脏直视术患者术后发生感染心内膜炎的相关因素。结果 288例心脏直视术患者中感染22例,感染率为7.64%;共培养分离病原菌23株,其中革兰阳性菌8株占34.78%,革兰阴性菌14株占60.87%,真菌1株占4.35%;酿脓链球菌和金黄色葡萄球菌对青霉素、四环素、环丙沙星、红霉素的耐药率较高,对替考拉宁、克拉霉素、利奈唑胺敏感;嗜麦芽寡养单胞菌对庆大霉素、头孢克肟、头孢哌酮的菌耐药率较高,大肠埃希菌对庆大霉素完全耐药,均对阿米卡星、美罗培南敏感;年龄、入住ICU时间是心脏直视术患者术后发生感染心内膜炎的相关因素(P<0.001)。结论心脏直视术患者术后发生感染心内膜炎的风险较高,临床应根据相关因素给予患者积极早期预防干预,同时根据病原菌及耐药情况,合理选择抗菌药物,提高临床综合疗效。OBJECTIVE To investigate the distribution and drug resistance of pathogens isolated from patients with infective endocarditis after cardiac surgery.METHODS A total of 288 patients who received the cardiac surgery in the hospital from Dec 2015 to Oct 2016 were recruited as the study objects,the incidence of nosocomial infection was statistically analyzed,the distribution and drug resistance of the pathogens were observed,and the related factors for the postoperative infective endocarditis were summarized by taking account of the clinical data.RESULTS Of the 288 patients who received the cardiac surgery,22 had the infection,with the infection rate 7.64%.Totally 23 strains of pathogens were isolated,8（34.78%）of which were gram-positive bacteria,14（60.87%）were gram-negative bacteria,and 1（4.35%）was fungus.The Streptococcus pyogenes strains were highly resistant to penicillin,tetracycline,ciprofloxacin and erythromycin but were susceptible to teicoplanin,clarithromycin and linezolid.The Stenotrophomonas maltophilia strains were highly resistant to gentamicin,cefixime and cefoperazone.The Escherichia coli strains were completely resistant to gentamicin and sensitive to amikacin and meropenem.The age and length of ICU stay were the related factors for the postoperative infective endocarditis in the patients after the cardiac surgery（P〈0.001）.CONCLUSIONThe patients are at high risk of infective endocarditis after the cardiac surgery.It is necessary for the hospital to actively take intervention measures according to the related factors in early stage and reasonably use antibiotics based on the distribution and drug resistance of the pathogens so as to improve the comprehensive clinical effect.

关 键 词：心脏直视术 感染心内膜炎 病原菌 耐药情况 相关因素 

分 类 号：R619.3[医药卫生—外科学]