摘要
目的探讨主动脉畸形患者感染心内膜炎的病原菌分布特点及其耐药性,对临床治疗进行指导。方法选取二叶式主动脉瓣畸形感染心内膜炎患者153例,对其临床资料进行回顾性分析,并行病原菌分离和耐药性分析。结果 153例患者共检出病原菌161株,其中革兰阳性菌123株,占76.40%,革兰阴性菌30株,占18.63%,真菌8株,占4.97%,排名前5位病原菌依次为酿脓链球菌、凝固酶阴性葡萄球菌、金黄色葡萄球菌、大肠埃希菌、铜绿假单胞菌,分别占37.27%、24.22%、13.04%、9.32%、3.73%;酿脓链球菌、凝固酶阴性葡萄球菌及金黄色葡萄球菌对利奈唑胺、万古霉素和替考拉宁的耐药率均为0,酿脓链球菌对青霉素、头孢曲松、头孢噻肟以及左氧氟沙星的耐药性相对较低<7.00%,而对克林霉素和红霉素的耐药性相对较高>50.00%;凝固酶阴性葡萄球菌仅对利福平较为敏感,耐药率<6.00%,而对青霉素类药物、头孢类药物和红霉素均表现出了很高的耐药性,耐药率>80.00%;金黄色葡萄球菌除对青霉素耐药性特别高以外,对其他药物的耐药率均<30.00%,其中对头孢唑林、头孢呋辛、庆大霉素以及利福平的耐药性<10.00%。结论二叶式主动脉瓣畸形感染心内膜炎患者病原菌存在多样性,在治疗的早期可根据经验给予联合用药治疗,并根据细菌培养和药敏试验结果随时对药物进行调整。
OBJECTIVE To investigate the distribution and drug resistance of the pathogens causing infectious endocarditis in the patients with bicuspid aortic malformation so as to guide the clinical treatment. METHODS A totalof 153 cases of bicuspid aortic valve malformation patients complicated with infectious endocarditis were enrolled inthe study, then the clinical data were retrospectively analyzed, and the isolation of pathogens and the analysis ofdrug resistance were performed. RESULTS There were totally 161 strains of pathogens isolated from 153 patients,including 123 （76. 40%） strains of gram-positive bacteria, 30 （18. 63%） strains of gram-negative bacteria,and 8（4. 97 % ） strains of fungi ; Streptococcus viridans ？ coagulase-negative Staphylococci,Staphylococcus aureus ,
Escherichia coli,and Pseudomonas aeruginosa ranked the top 5 species of pathogens,accounting for 37. 27%,24. 22 % , 13. 04%,9. 32, and 3.73%, respectively. The drug resistance rates of the S. viridans,coagulase-neg-ative Staphylococci,and S. aureus to linezolid, vancomycin, and teicoplanin were 0; the drug resistance rates ofthe S. viridans to penicillin, ceftriaxone; cefotaxime, and levofloxacin were less than 7. 00%,while the drug resistance rates to clindamycin and erythromycin were more than 50. 00 % ; the coagulase-negative Staphylococci washighly susceptible to rifampicin, with the drug resistance rate less than 6. 00% , while the strains were highly resistant to penicillins,cephalosporins, and erythromycin, with the drug resistance rate more than 80. 00%; Thedrug resistance rate of the S. aureus was less than 30. 00% against all the antibiotics except for penicillin, and thedrug resistance rates to cefazolin, cefuroxime, gentamicin, and rifampicin were less than 10. 00%. CONCLUSIONThere are a variety of pathogens causing infectious endocarditis in the patients with bicuspid aortic valve malformation, the combination drug therapy should be given during the early stage of treatment based on the empirical ad-ministration, and the use of antibiotics should be adjusted in line with the results of the bacterial culture and drugsusceptibility testing.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2013年第17期4305-4307,共3页
Chinese Journal of Nosocomiology
基金
黔南州卫生局专项自筹课题(QNW-2010B-012)
关键词
二叶式主动脉瓣畸形
感染性心内膜炎
病原菌
耐药性
Bicuspid aortic valve malformation； Infectious endocarditis； Pathogen； Drug resistance
