感染性心内膜炎患者致病菌谱及控制的临床研究  

Clinical study on pathogen spectrum and control in patients with infective endocarditis

作　　者：张玉睿 张斌 郭昕卉 张维福 郭强 ZHANG Yurui;ZHANG Bin;GUO Xinhui;ZHANG Weifu;GUO Qiang(The Second Affiliated Hospital of Shandong First Medical University,Taian 271000,China;The Fifth People's Hospital of Jinan)

机构地区：[1]山东第一医科大学第二附属医院,山东泰安271000 [2]山东省济南市第五人民医院

出　　处：《包头医学院学报》2022年第4期28-32,共5页Journal of Baotou Medical College

摘　　要：目的:了解感染性心内膜炎患者致病菌感染谱,为控制该病的临床经验性使用抗菌药物提供依据。方法:选取2018年1月~2020年12月期间山东第一医科大学第二附属医院和山东省济南市第五人民医院171例感染性心内膜炎患者,按有无心脏基础性疾病分成A组无心脏基础性疾病83例,B组有心脏基础性疾病88例,分别进行静脉血培养,分离菌株,分析病原微生物特点及其药物敏感性情况。结果:A组83例患者中检出病原菌103株,其中革兰阳性菌主要为草绿色链球菌、金黄色葡萄球菌,革兰阴性菌主要为大肠埃希菌、鲍氏不动杆菌。革兰氏阳性菌株(57.28%)占比远高于革兰氏阴性菌株(33.01%)与真菌(9.71%)。B组88例患者中检出病原菌99株,其中革兰阳性菌主要为草绿色链球菌、金黄色葡萄球菌,革兰阴性主要为大肠埃希菌、鲍氏不动杆菌。革兰氏阳性菌株(79.80%)占比远高于革兰氏阴性菌株(19.19%)与真菌(1.01%)。两组患者主要致病菌是草绿色链球菌和金黄色葡萄球菌,A组革兰阴性菌和真菌显著高于B组,革兰阳性菌显著低于B组,差异有统计学意义(P<0.05)。药敏结果显示:两组患者主要革兰阳性菌对青霉素、氨苄西林、头孢唑林耐药率较高,对左氧氟沙星、利福平、莫西沙星、万古霉素利福平耐药率较低,利奈唑胺不具有耐药性;两组患者主要革兰阴性菌对头孢唑林、头孢曲松、头孢哌酮耐药率较高,对环丙沙星、左氧氟沙星、阿米卡星、美罗培南耐药率较低,亚胺培南不具有耐药性。金黄色葡萄球菌对左氧氟沙星、万古霉素,鲍氏不动杆菌对头孢哌酮耐药率差别较大,经统计学分析,差异无统计学意义(P>0.05)。结论:依据细菌病原学的分布、掌握细菌耐药的最新动态变迁、了解有无心脏基础性疾病,指导临床合理应用抗菌药物。Objective:To understand the infection spectrum of pathogenic bacteria in patients with infective endocarditis,and to provide the basis for the empirical use of antimicrobial agents to control the disease.Methods:A total of 171 patients with infective endocarditis were divided into group A(without basic heart disease)and group B(with basic heart disease).Venous blood culture was conducted,strains were isolated,and characteristics of pathogenic microorganisms and drug sensitivity were analyzed.Results:103 strains of pathogenic bacteria were detected in the 83 patients of group A,among which the gram-positive bacteria were mainly Streptococcus virifolia and Staphylococcus aureus,while the gram-negative bacteria were mainly Escherichia coli and Acinetobacter baumannii.The proportion of gram-positive strains(57.28%)was much higher than that of gram-positive strains(33.01%)and fungi(9.71%).88 patients in group B were detected in 99 strains pathogenic bacteria,including gram-positive bacteria mainly streptococcus viridans,staphylococcus aureus,gram-negative mainly E.coli and s.boydii acinetobacter.The proportion of gram positive strains(79.80%)was much higher than that of gram-positive strains(19.19%)and fungi(1.01%).The main pathogenic bacteria in 2 groups were Streptococcus aeruginosa and Staphylococcus aureus.Gram-negative bacteria and fungi in group A were significantly higher than those in group B,and Gram-positive bacteria were significantly lower than those in group B,with statistical significance(P<0.05).The drug sensitivity results showed that the drug resistance rates of the main gram-positive bacteria to penicillin,ampicillin and cefazolin were higher in the two groups,while the drug resistance rates to levofloxacin,rifampicin,moxifloxacin and vancomycin and rifampicin were lower in the two groups,and linezolid was not resistant.The drug resistance rates of the main gram-negative bacteria to cefazolin,ceftriaxone and cefoperazone were higher in the two groups,while the drug resistance rates to ciprofloxacin,l

关 键 词：感染性心内膜炎 病原菌 抗菌药物 耐药性 

分 类 号：R44[医药卫生—诊断学]