205例感染性心内膜炎患者病原菌分布和预后影响因素分析  

Etiological characteristics and prognostic factor profiling of 205 cases of infective endocarditis

作　　者：秦祥玉 崔岸 陈明泉 QIN Xiangyu;CUI An;CHEN Mingquan(Department of Infectious Diseases,Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response,National Medical Center for Infectious Diseases,Huashan Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院感染科,上海市传染病与生物安全应急响应重点实验室,国家传染病医学中心,上海200040

出　　处：《中国感染与化疗杂志》2023年第3期293-298,共6页Chinese Journal of Infection and Chemotherapy

摘　　要：目的分析感染性心内膜炎(infective endocarditis,IE)患者病原菌分布和预后影响因素。方法收集2014年1月—2021年2月复旦大学附属华山医院收治的205例IE患者临床资料,包括人口学资料、临床表现、实验室检查、病原学检查和影像学检查结果等。结果205例IE患者分为自体瓣膜心内膜炎(native valve endocarditis,NVE)组和人工瓣膜心内膜炎(prosthetic valve endocarditis,PVE)组。NVE组血培养阳性67例(44.4%,67/151),检出草绿色链球菌48株(69.6%,48/69),对红霉素、克林霉素耐药率分别为33.3%、25.0%;高血压、肺部感染是IE患者并发心力衰竭的危险因素(P<0.05)。PVE组血培养阳性18例(33.3%,18/54),检出葡萄球菌9株(47.4%,9/19),对青霉素、苯唑西林耐药率分别为55.6%、44.4%。结论NVE患者血培养检出病原菌以草绿色链球菌为主,高血压史、发生肺部感染增加患者并发心力衰竭风险;PVE患者血培养主要病原菌为葡萄球菌。Objective To analyze the etiological characteristics and prognostic factors of infective endocarditis(IE).Methods The clinical data such as demographics,clinical manifestations,laboratory findings,microbiological tests and imaging findings were reviewed and analyzed retrospectively for 205 IE patients who were admitted to Huashan Hospital,Fudan University from January 2014 to February 2021.Results The 205 patients with IE were assigned to native valve endocarditis(NVE)group or prosthetic valve endocarditis(PVE)group.In the NVE group,blood culture was positive in 67 cases(44.4%),48 strains(69.6%)of Streptococcus viridans were isolated.Antimicrobial susceptibility testing showed that 33.3%and 25.0%of these strains were resistant to erythromycin and clindamycin,respectively.Hypertension and pneumonia were risk factors for heart failure in NVE patients(P<0.05).Blood culture was positive in 18(33.3%)patients in PVE group,9 strains(47.4%)of Staphylococcus were isolated.About 55.6%and 44.4%of the Staphylococcus isolates were resistant to penicillin and benzocillin,respectively.Conclusions The pathogenic bacteria isolated from blood culture in NVE patients were mainly Streptococcus viridans.Hypertension and pneumonia may increase the risk of heart failure in NVE patients.Staphylococcus is the main pathogen in PVE patients.

关 键 词：感染性心内膜炎 病原菌 耐药性 心力衰竭 

分 类 号：R515[医药卫生—内科学]