感染性心内膜炎患者的病原菌分布及药敏分析

Pathogens distribution and drug susceptibility among patients with infective endocarditis

目的分析感染性心内膜炎(IE)的病原菌分布及其对各类抗菌药物的耐药性,为临床医师制定治疗方案提供参考依据。方法选取2008年1月-2012年12月纳入的342例患者送样血液标本,有103例血培养结果阳性的IE患者作为研究对象,对其血样中的病原菌分布和耐药性进行分析。结果在IE患者血液标本检出的病原菌中,革兰阳性菌的比例最高,共检出90株,占87.4%,革兰阴性菌检出9株,占8.7%,真菌检出4株,占3.9%;革兰阳性菌对红霉素和青霉素的耐药性较高,耐药率分别为44.9%和29.2%,而对万古霉素、利福平、呋喃妥因、亚胺培南的敏感度较高,耐药率分别为1.1%、2.2%、3.4%和5.6%;革兰阴性菌对头孢唑林、磺胺甲噁唑/甲氧苄啶、头孢噻吩、头孢曲松的耐药性较高,耐药率分别为77.8%、66.7%、55.6%和55.6%,而对亚胺培南、阿米卡星的敏感度较高,耐药率均为11.1%。结论在IE患者血样的病原菌中,革兰阳性菌的比例最高,耐万古霉素金黄色葡萄球菌和耐亚胺培南铜绿假单胞菌的出现值得引起注意。

OBJECTIVE To analyze the pathogen distribution and drug resistance to different antibiotics of the patients with infective endocarditis （IE） to provide references for clinical treatment projects .METHODS Among the 342 cases of blood samples from Jan 2008 to Dec 2012 ,103 patients suffered from IE with positive blood culture results were selected as research objects to analyze the pathogen distribution and drug resistance of the blood samples .RESULTS Among the pathogens of IE patient blood samples ,90 strains of gram positive bacteria were found ,accounting for the highest rate 87 .4% .gram negative bacteria were 9 strains （accounting for 8 .7% ） while 4 strains of fungi were detected （accounting for 3 .9% ）;the drug resistance of gram positive bacteria to erythromycin and penicillin was pretty high and their resistance rates were 44 .9% and 29 .2% respectively .The drug susceptibility to vancomycin ,nitrofurantoin ,rifampin ,imipenem were very high and their resistance rates were 1 .1% ,2 .2% ,3 .4% and 5 .6% respectively ;the drug resistance of gram negative bacteria to cefazolin , sulfamethoxazole/trimethoprim ,cefalotin , ceftriaxone was also high and their resistance rates were 77 .8% , 66 .7% ,55 .6% and 55 .6% respectively .The drug susceptibility to imipenem ,tazocin ,amikacin was pretty high and their drug resistance rates were all 11 .1% .CONCLUSION As for the pathogens in the blood samples of the patients with IE ,the gram positive bacteria counts for the highest proportion .The emergence of Staphylococcus aureus resistance to vancomycin and Pseudomonas aeruginosa resistance to imipenem are both worthy of attention .