感染性心内膜炎患者的血培养病原菌分布及耐药性分析  

Analysis of the distribution and drug resistance of pathogenic bacteria in blood culture of patients with infective endocarditis

作　　者：黄德仪[1] 林蔡弟[1] 蒯魏 卢芬[1] 李晓明[1] 廖火生[1] 魏文婷[1] 喻志宏[1] 胡湘明[1] Huang De-yi;Lin Cai-di;Kuai Wei;Lu Fen;Li Xiao-ming;Liao Huo-sheng;Wei Wen-ting;Yu Zhi-hong;Hu Xiang-ming(Guangdong Provincial People’s Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080)

机构地区：[1]广东省人民医院广东省医学科学院,广州510080

出　　处：《中国抗生素杂志》2020年第2期170-174,共5页Chinese Journal of Antibiotics

基　　金：广东省医学科学技术研究基金项目(No.A2016057)。

摘　　要：目的 分析感染性心内膜炎患者的血培养病原菌构成及药敏结果,为患者的临床用药提供参考依据。方法 选取我科(广东省人民医院二区)2015年1月—2018年12月473例住院治疗的感染性心内膜炎患者作为对象,对其血培养结果进行病原菌分布和耐药性分析。结果 473例感染性心内膜炎患者血培养阳性97例,阳性率20.8%。共分离出病原菌102株,其中革兰阳性菌92株占90.20%,革兰阴性菌4株占3.92%,真菌6株占5.88%。链球菌属对青霉素、头孢曲松敏感率分别81.43%、87.30%,左氧氟沙星敏感率为79.37%,对克林霉素、红霉素、四环素耐药率较高,对氯霉素耐药率低。葡萄球菌对青霉素的耐药率为100%、对苯唑西林耐药率50%,克林霉素、红霉素次之,对左氧氟沙星、庆大霉素和利福平的耐药率较低,均<10.00%。耐甲氧西林葡萄球菌检出率较高,耐甲氧西林金黄色葡萄球菌(MRSA)4株占66.7%,耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)4株占50%,肠球菌属对青霉素、庆大霉素耐药率均为16.67%,对喹诺酮类敏感,对红霉素、四环素耐药率较高。均未见对万古霉素、替考拉宁、利奈唑胺耐药菌株。真菌均对5-氟胞嘧啶、氟康唑、伊曲康唑、伏立康唑、两性霉素B均敏感。结论 链球菌和葡萄球菌是感染性心内膜炎的主要致病菌。结合药敏分析结果,在经验性治疗感染性心内膜炎时,选用青霉素联合氨基糖苷类药物治疗存在较大风险,尤其对于急性重症感染合并耐药菌感染高危因素的患者,万古霉素是理想的选择。Objective To analyze the composition of pathogenic bacteria in blood culture of patients with infective endocarditis and the results of drug sensitivity,so as to provide a reference for the clinical medication of patients.Methods 473 hospitalized patients with infective endocarditis from January 2015 to December 2018 in our department(the second district of Guangdong general hospital)were selected as subjects,and their blood culture results were analyzed for pathogen distribution and drug resistance.Results 102 strains of pathogenic bacteria were isolated from 473 patients with infective endocarditis,with a positive rate of 20.8%.Among them,92 strains of Gram-positive bacteria accounted for 90.20%,4 strains of Gram-negative bacteria accounted for 3.92%,and 6 strains of fungi accounted for 5.88%.The susceptibility rates of Streptococcus to penicillin and ceftriaxone were 81.43%and 87.30%,respectively,that of levofloxacin was 79.37%,and that of clindamycin,erythromycin and tetracycline were higher,but that of chloramphenicol was lower.The drug resistance rate of Staphylococcus to penicillin was 100%,that to benzocillin was 50%,followed by those to clindamycin and erythromycin,and those to levofloxacin,gentamicin,and rifampicin was low(all<10.00%).Methicillin-resistant Staphylococcus aureus(MRSA)strains accounted for 66.7%.Methicillin-resistant coagulase-negative Staphylococcus aureus(MRCNS)strains accounted for 50%.Enterococcus was 16.67%resistant to penicillin and gentamicin,sensitive to quinolones,and resistant to erythromycin and tetracycline.Vancomycin,teicoplanin,and linezolid resistant strains were observed.All fungi were sensitive to 5-fluorouracil,fluconazole,itraconazole,voriconazole,and amphotericin B.Conclusion Streptococcus and Staphylococcus were the main pathogens of infective endocarditis.Combined with the results of drug sensitivity analysis,penicillin combined with aminoglycoside drugs is a risky choice for the empirical treatment of infective endocarditis(IE),especially for patients with severe ac

关 键 词：感染性心内膜炎 病原菌 血培养 耐药性 

分 类 号：R978[医药卫生—药品]