摘要
目的:研究感染性心内膜炎(IE)患者细菌病原学,并进行药敏试验分析常见病原菌的耐药性。方法:选取2014年6月至2019年3月,我院收治的IE患者127例为研究对象,采集其血液标本进行血培养,对阳性标本进一步菌种分离计数,并进行药敏试验,分析IE患者血培养结果及致病菌分布情况及常见致病菌对抗菌药物的耐药性。结果:127例IE患者血液标本经血培养,检出细菌阳性70例,阳性率为55.1%;70例阳性患者致病菌中革兰阳性菌62株(88.6%),革兰阴性菌8株(11.4%),革兰阳性菌以链球菌属34株(48.6%)和葡萄球菌属28株(40.0%)为主,其中金黄色葡萄球菌(25.7%)和草绿色链球菌(21.5%)占比最高;草绿色链球菌对阿米卡星完全耐药,对克林霉素耐药率高达80%,对氨苄西林耐药率为86.7%,对万古霉素、利奈唑胺、头孢哌酮舒巴坦不具有耐药性,对头孢噻肟、哌拉西林耐药率较低(6.7%、13.3%),对其他常用抗菌药耐药性在20%~54%间;金黄色葡萄球菌对青霉素、克林霉素、哌拉西林、阿米卡星的耐药率超过55%,对万古霉素、利福平耐药率低于6%,对利奈唑胺不具有耐药性,对其他常用抗菌药耐药率在22%~39%间。结论:IE患者病原菌主要由链球菌属和葡萄球菌属构成,其中草绿色链球菌和金黄色葡萄球菌占比最高(21.4%、25.7%),草绿色链球菌对万古霉素、利奈唑胺、头孢哌酮舒巴坦不具有耐药性,对阿米卡星完全耐药;对万古霉素、利福平耐药率低于6%,对利奈唑胺不具有耐药性;临床治疗IE可根据病原菌分布情况及其耐药性合理选择抗菌药。
Objective:To study the bacterial etiology of infective endocarditis(IE)patients,and to conduct drug sensitivity test to analyze the drug resistance of common pathogens.Methods:127 cases of IE patients admitted to our hospital from June 2014 to March 2019 were selected.Blood samples were collected for blood culture and isolation,and drug sensitivity test was also conducted.The result of blood culture,distribution of pathogens and resistance of common pathogens to antibiotics were analyzed.Results:A total of 70(55.1%)strains of pathogenic bacteria were detected in 127 IE patients,including 62 strains of gram-positive bacteria(88.6%)and 8 strains of gram-negative bacteria(11.4%).34 strains of streptococcus(48.6%)and 28 strains of staphylococcus(40.0%)were the main gram-positive bacteria,among which staphylococcus aureus(25.7%)and Viridans Streptococci(21.5%)accounted for the highest proportion.Viridans Streptococci was completely resistant to amikacin,and its resistance rate to clindamycin was 80%,the resistance rate to ampicillin was 86.7%.Viridans Streptococci was not resistant to vancomycin,linezolid,or cefoperazone sulbactam;Viridans Streptococci had low resistance rate to cefotaxime and piperacillin(6.7%,13.3%),and its resistance to other commonly used antibacterial drugs was between 20%and 54%;The resistance rate of staphylococcus aureus to penicillin,clindamycin,piperacillin and amikacin exceeded 55%.The resistance rate of Staphylococcus aureus to vancomycin and rifampicin was lower than 6%,and Staphylococcus aureus had no resistance to linezolid.The resistance rate of Staphylococcus aureus to other commonly used antibiotics was between 22% and 39%.Conclusions:The pathogenic bacteria of IE patients are mainly composed of Sireptococcus and Staphylococcus,among which,Viridans Streptococci and staphylococcus aureus account for the highest proportion(21.4%,25.7%).In clinical treatment of IE,antimicrobial agents can be selected reasonably according to the distribution of pathogens and their drug resistance.
作者
谭艳杰
丁进叶
姚玲玲
金银生
龚勇
TAN Yanjie;DING Jinye;YAO Lingling;JIN Yinsheng;GONG Yong(Department of CCU,Shiyan People's Hospital(People's Hospital Affiliated to Hubei Medical College),Shiyan 442000,China)
出处
《心肺血管病杂志》
2020年第9期1054-1056,1061,共4页
Journal of Cardiovascular and Pulmonary Diseases
关键词
感染性心内膜炎
细菌病原学
耐药性
Infective endocarditis
Bacterial etiology
Drug resistance
