南阳地区感染性心内膜炎患者的致病菌与临床特征研究  

A study on pathogenic bacteria and clinical characteristics of patients with infectious endocarditis in Nan yang region

作　　者：穆清[1] 李志英 张景迪 张占海[1] MU Qing;LI Zhiying;ZHANG Jingdi;ZHANG Zhanhai(The First Affiliated Hospital of Nanyang Medical University,Nanyang 473058,Henan,China)

机构地区：[1]南阳医学高等专科学校第一附属医院,河南南阳473058

出　　处：《中国病原生物学杂志》2024年第6期675-679,共5页Journal of Pathogen Biology

摘　　要：目的探析感染性心内膜炎患者的致病菌分布特点与临床特征。方法选取132例本院心血管内科接诊的感染性心内膜炎患者为本次研究对象。运用回顾性分析法,通过院内电子病历系统对参与本次研究所有患者的临床资料进行分析。采集患者静脉血标本进行病原菌鉴定与药敏试验。对草绿色链球菌感染组与非草绿色链球菌感染组患者的临床特征进行对比分析。结果132例感染性心内膜炎患者中,86.36%有心脏基础病,其中先天性心脏病占比23.48%,主要为室间隔缺损;风湿性心脏瓣膜病占比6.82%,主要为单纯主动脉瓣膜病变;非风湿性心脏瓣膜病占比23.48%,主要为单纯主动脉瓣病变;心脏手术及介入治疗后发病占比28.79%,主要为先天性心脏病术后;其他心脏基础病占比3.79%,主要为冠心病。98例并发心功能不全,57例并发脏器栓塞,12例并发急性肾功能不全,10例并发出血性脑卒中,9例并发转移脓肿,7例并发多脏器功能衰竭。共检出病原菌132株,其中革兰阳性菌90株,革兰阴性菌34株,真菌8株。革兰阳性菌主要为草绿色链球菌,革兰阴性菌主要为大肠埃希菌,真菌主要为白色假丝酵母菌。草绿色链球菌对红霉素、克林霉素、阿奇霉素的耐药率较高,分别为72.46%、60.87%、66.67%,对青霉素、哌拉西林/他唑巴坦、头孢吡肟、氯霉素的敏感性较高,未产生对万古霉素、利奈唑胺的耐药株。草绿色链球菌感染组与非草绿色链球菌感染组患者的性别、先天性心脏病、入院前持续时间、心脏瓣膜听诊区杂音、肌肉骨骼疼痛、心功能不全、急性肾功能不全、发生二尖瓣赘生物、发生三尖瓣赘生物差异有统计学意义(P<0.05),年龄、发热、贫血、并发栓塞、发生主动脉瓣赘生物差异无统计学意义(P>0.05)。结论感染性心内膜炎患者,多患有心脏基础疾病,病原菌主要为草绿色链球菌,对大环内酯类抗菌药物Objective To explore the distribution and clinical characteristics of pathogenic bacteria in patients with infectious endocarditis. Methods 132 patients with infectious endocarditis admitted to the cardiovascular department of our hospital were selected as the study subjects. By retrospective analysis method, the clinical data of all patients participating was analyzed in this study through the hospital's electronic medical record system. The venous blood samples were collected from patients for pathogen identification and drug sensitivity testing. The clinical characteristics between patients infected with Streptococcus viridans and those not infected with Streptococcus viridans were comparative analyzed. Results Among 132 patients with infective endocarditis, 86.36% had underlying heart disease, with congenital heart disease accounting for 23.48%,mainly ventricular septal defect;Rheumatic heart valve disease accounted for 6.82%,mainly consisting of simple aortic valve disease;Non rheumatic heart valve disease accounted for 23.48%,mainly due to simple aortic valve disease;The incidence rate after cardiac surgery and interventional treatment was 28.79%,mainly for congenital heart disease after surgery;Other underlying heart diseases accounted for 3.79%,mainly coronary heart disease. 98 cases were complicated with heart failure, 57 cases with organ embolism, 12 cases with acute renal failure, 10 cases with hemorrhagic stroke, 9 cases with metastatic abscess, and 7 cases with multiple organ failure. A total of 132 pathogenic bacteria were detected, including 90 Gram positive bacteria, 34 Gram negative bacteria, and 8 fungi. Gram positive bacteria were mainly Streptococcus viridans,Gram negative bacteria were mainly Escherichia coli,and fungi were mainly Candida albicans. Streptococcus viridans had a high resistance rate to erythromycin, clindamycin, and azithromycin, with rates of 72.46%,60.87%,and 66.67%,respectively. It was highly sensitive to penicillin, piperacillin/tazobactam, cefepime, and chloramphenicol, an

关 键 词：感染性心内膜炎 草绿色链球菌 临床特征 

分 类 号：R542.41[医药卫生—心血管疾病] R446.5[医药卫生—内科学]