抗生素治疗厌氧菌性心包炎的研究进展

Progress in the Treatment of Pericarditis Caused by Anaerobic Bacteria

自厌氧菌性心包炎患者中分离出的主要致病厌氧菌包括革兰阴性杆菌(大多为脆弱拟杆菌属)、消化链球菌属、梭杆菌、梭形杆菌属、双岐杆菌属及放线菌属等。引起厌氧菌性心包炎的途径主要是:(1)邻近感染灶的播散;(2)心脏内感染灶的播散;(3)血行播散;(4)胸部贯通伤或心胸外科手术时的直接种植。由于近年来厌氧革兰阴性杆菌对青霉素及其他抗生素的耐药增加,因此厌氧菌的鉴定与药物敏感试验对厌氧菌性心包炎的治疗至关重要。厌氧菌性心包炎内科治疗主要是应用对致病厌氧菌有效的抗生素。

This review describes progress in the management of pericarditis associated with anaerobic bacterial infection. The predominant anaerobes isolated from patients with pericarditis are Gram-negative bacilli （mostly Bacteroides fragilis）, Peptostreptococcus, Clostridium, Fusobacterium, Bifidobacterium and Actinomyces spp. The primary factors that may be responsible for the development of anaerobic pericarditis include： （I） pathogens spread from a contiguous focus of infection, （2） pathogens spread from a focus of infection within the heart, （3） haematogenous infection, and （4） direct inoculation as a result of a thoracic penetrating injury or cardiothoracic surgery. In recent years, penicillin- and other antimicrobial-resistance of anaerobic Gram-negative bacilli have significantly increased, identification and antimicrobial susceptibility testing, therefore, become essential for the management of infections caused by anaerobic bacteria. The mainstay of medical treatment for pericarditis associated with anaerobes is the antibiotic therapy effective against abovespecified organisms.