摘要
目的分析人工心脏瓣膜置换术后感染性心内膜炎(Prosthetic valve endocarditis,PVE)患者的临床特征、病原微生物分布规律、耐药性及致病相关分子特征,为PVE的精准诊疗与防控提供实验依据。方法回顾性纳入2021年3月-2025年5月本院收治的120例PVE患者,收集临床资料;采用BDBACTEC FX400血培养仪及VITEK 2 Compact系统进行病原菌分离鉴定,参照CLSI 2024版标准行药敏试验;通过PCR检测草绿色链球菌cpsA基因、金黄色葡萄球菌icaA及fnbA基因,结晶紫染色法评估生物膜形成能力。结果120例患者平均年龄(65.3±8.7)岁,56.67%(68/120)合并高血压,晚期PVE(术后>12个月)占62.5%(75/120),发热(90.0%,108/120).心脏杂音(70.83%,85/120)为主要临床表现,超声心动图赘生物检出率95.83%(115/120)。共检出病原菌126株,革兰阳性菌占72.22%(91/126),其中草绿色链球菌(31.75%,40/126)、金黄色葡萄球菌(20.63%,26/126)为主;经导管主动脉瓣置换术(TAVR)患者肠球菌属构成比(25.0%,9/36)显著高于外科主动脉瓣置换术(SAVR)患者(10.0%,9/90)(P<0.05),且屎肠球菌差异更显著(8.33% vs 1.11%,P<0.05)。草绿色链球菌对红霉素耐药率77.5%(31/40),金黄色葡萄球菌对青霉素耐药率96.15%(25/26),两类菌对万古霉素.利奈唑胺均敏感。cpsA阳性草绿色链球菌生物膜强阳性率(63.64%,14/22)显著高于阴性株(5.56%,1/18)(P<0.05);icaA阳性金黄色葡萄球菌生物膜强阳性率(80.0%,16/20)显著高于阴性株(0%,0/6)(P<0.05)。fnbA基因阳性率69.23%(18/26),未发现与生物膜形成相关。结论PVE患者以晚期发病为主,革兰阳性菌为主要致病菌,TAVR患者肠球菌属感染风险更高;草绿色链球菌,金黄色葡萄球菌耐药性突出但仍对万古霉素等敏感;cpsA、icaA基因与病原菌生物膜形成密切相关,可作为PVE致病机制研究的关键靶点。
Objective To analyze the clinical characteristics,distribution pattern of pathogenic microorganisms,drug resistance,and pathogenic-related molecular features of patients with Prosthetic Valve Endocarditis(PVE)after artificial heart valve replacement,so as to provide experimental evidence for the precise diagnosis,treatment,prevention,and control of PVE.Methods A total of 120 PVE patients admitted to our hospital from March 2021 to May 2025 were retrospectively included,and their clinical data were collected.The BD BACTEC FX400 blood culture instrument and VITEK 2 Compact system were used for the isolation and identification of pathogenic bacteria.Drug susceptibility tests were performed in accordance with the CLSI 2024 standards.PCR was used to detect the cpsA gene of Streptococcus viridans,and the ica A and fnbA genes of Staphylococcus aureus.The crystal violet staining method was applied to evaluate the biofilm-forming ability.Results The average age of the 120patients was(65.3±8.7)years,and 56.67%(68/120)were complicated with hypertension.Late-stage PVE(more than 12 months after surgery)accounted for 62.5%(75/120).The main clinical manifestations were fever(90.0%,108/120)and heart murmur(70.83%,85/120).The detection rate of vegetation by echocardiography was 95.83%(115/120).A total of 126 strains of pathogenic bacteria were detected,among which gram-positive bacteria accounted for 72.22%(91/126),with S.viridans(31.75%,40/126)and S.aureus(20.63%,26/126)being the main ones.The proportion of Enterococcus in patients who underwent Transcatheter Aortic Valve Replacement(TAVR)(25.O%,9/36)was significantly higher than that in patients who underwent Surgical Aortic Valve Replacement(SAVR)(10.0%,9/90)(P<0.05),and the difference in E.faecium was more significant(8.33%vs 1.11%,P<0.05).The drug resistance rate of S.viridans to erythromycin was 77.5%(31/40),and that of S.aureus to penicillin was 96.15%(25/26).Both types of bacteria were sensitive to vancomycin and linezolid.The strong positive rate of biofilm in cpsA-positive S.viridans(63.64%,14/22)was significantly higher than that in cpsA-negative strains(5.56%,1/18)(P<0.05).The strong positive rate of biofilm in icaA-positive S.aureus(80.0%,16/20)was significantlyhigher than that in icaA-negative strains(0%,0/6)(P<0.05).The positive rate of the fnbA gene was 69.23%(18/26),and no correlation with biofilm formation was found.Conclusion Most PVE patients have late-onset disease,and gram-positive bacteria are the main pathogenic bacteria.Patients who undergo TAVR have a higher risk of Enterococcus infection.Streptococcus viridans and S.aureus show prominent drug resistance but are still sensitive to vancomycin and other drugs.The cpsA and icaA genes are closely related to the biofilm formation of pathogenic bacteria and can be used as key targets in the study of the pathogenic mechanism of PVE.
作者
刘雨晴
张姗
丁一飞
胡亚男
LIU Yuqing;ZHANG Shan;DING Yifei;HU Yanan(Affiliated Hospital of Xuzhou Medical University,Xuzhou 221006,Jiangsu,China)
出处
《中国病原生物学杂志》
北大核心
2026年第4期467-471,共5页
Journal of Pathogen Biology
关键词
人工心脏瓣膜置换术
感染性心内膜炎
病原微生物
耐药性
生物膜
致病基因
artificial heart valve replacement
infective endocarditis
pathogenic microorganism
drug resistance
biofilm
pathogenic gene
