我院162例感染性心内膜炎患者的临床和病原学特征分析

发布时间：2018-06-24 03:59

本文选题：感染性心内膜炎 + 病原菌　；参考：《中国药房》2017年29期

【摘要】：目的:为临床合理使用抗菌药物提供参考。方法:选取2014年1月-2016年6月我院感染性心内膜炎(IE)住院患者162例,对其基本情况,赘生物分布情况,临床表现及检查指标,标本类型、病原菌构成及耐药情况,治疗情况与结局等临床和病原学资料进行回顾性分析。结果:162例IE患者的男女比例为1.9:1,年龄多集中在41~60岁,有146例患者合并心脏基础疾病(占90.1%)。有145例患者为赘生物阳性,且多累及左心系统,以主动脉瓣赘生物最为常见(59例,占40.7%)。出现发热的患者有130例,其中白细胞计数、中性粒细胞百分比升高的分别有66、104例,红细胞计数、血红蛋白降低的分别有69、100例,丙氨酸转氨酶、天冬氨酸转氨酶、血肌酐水平升高的分别22、45、16例。162例IE患者共送检血液标本696份,阳性标本282份(阳性率为40.5%);有78例患者的血培养结果呈阳性(占48.1%)。共检出病原菌88株,含革兰氏阳性菌84株(占95.5%,以链球菌属细菌为主)和革兰氏阴性菌4株(占4.5%)。链球菌属细菌对青霉素的耐药率为30.4%;12株葡萄球菌属细菌均对青霉素耐药,对苯唑西林的耐药率为50.0%;肠球菌属细菌对青霉素、苯唑西林、阿米卡星耐药;但上述细菌对万古霉素、替考拉宁、利奈唑胺敏感,耐药率均为0。162例IE患者中,有140例患者行心脏外科手术清除赘生物(占86.4%);158例患者治愈或病情好转,2例死亡,2例自行出院。结论:我院IE患者以男性居多,且多合并有心脏基础疾病;多数患者可见心脏赘生物,以左心赘生物更为常见;发热患者居多,并伴有贫血、肝肾功能损害等症状;引发IE的病原菌以革兰氏阳性菌为主,链球菌属仍是最常见的菌种,耐药情况不容乐观。临床应结合当地病原学资料经验性选择抗菌药物,并根据药敏试验结果及时调整用药方案,以确保抗感染治疗的有效性和安全性。
[Abstract]:Objective: to provide reference for rational use of antimicrobial agents in clinic. Methods: 162 inpatients with infective endocarditis (IE) from January 2014 to June 2016 were selected, and their basic condition, distribution of neoplasm, clinical manifestation and examination index, type of specimen, composition of pathogenic bacteria and drug resistance were analyzed. The clinical and etiological data of treatment and outcome were analyzed retrospectively. Results the ratio of male to female was 1.9: 1 in 162 cases of IE. The age was mostly 41 ~ 60 years old. 146 cases (90.1%) were complicated with basic heart disease. 145 cases were positive for vegetations, and most of them were involved in the left cardiac system. Aortic valve vegetations were the most common (59 cases, 40.7%). There were 130 cases of fever, including 66104 cases of leukocyte count, increased percentage of neutrophils, 69100 cases of red blood cell count, and decreased hemoglobin, alanine aminotransferase, aspartate aminotransferase, alanine aminotransferase and aspartate aminotransferase. There were 696 blood samples (40.5%) and 78 cases (48.1%) were positive in blood culture. A total of 88 strains of pathogenic bacteria were detected, including 84 strains of Gram-positive bacteria (95.5%) and 4 strains of Gram-negative bacteria (4.5%). The resistance rate of Streptococcus to penicillin was 30.4 / 12 strains of Staphylococcus were all resistant to penicillin and to oxacillin was 50.0. Enterococcus bacteria were resistant to penicillin, oxacillin and amikacin; but the above-mentioned bacteria were resistant to vancomycin, Teicoplanin and linazolamide were sensitive and the drug resistance rates were all 0.162 cases of IE. One hundred and forty four patients underwent cardiac surgery to remove vegetations (86.4%). One hundred and fifty-eight patients were cured or improved. 2 cases died and 2 cases were discharged from hospital by themselves. Conclusion: the majority of IE patients in our hospital are male, and most of them are complicated with basic heart diseases, most of them have cardiac neoplasms, most of them are left ventricular neoplasms, fever patients are mostly accompanied with anemia, liver and kidney function damage, and so on. Gram-positive bacteria are the main pathogens causing IE, Streptococcus is still the most common species, drug resistance is not optimistic. In order to ensure the effectiveness and safety of anti-infective therapy, clinical experience should be combined with the local etiological data to select antibiotics and adjust the drug regimen according to the results of drug sensitivity test.
【作者单位】：第三军医大学第二附属医院药学部;
【基金】：第三军医大学第二附属医院临床科研项目(No.2014YLC35)
【分类号】：R542.4

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