活动期感染性心内膜炎病原菌构成、药敏分析及早期外科治疗62例

Analysis of pathogens and drug sensitivity and early surgical treatment in 62 patients with active infective endocarditis

目的 回顾性分析活动期感染性心内膜炎患者血培养及药敏结果,为临床合理选择抗菌药提供依据,探讨早期手术治疗活动期感染性心内膜炎的疗效.方法 2010年5月至2014年7月北京协和医院共收治62例活动期感染性心内膜炎患者,其中男46例,女16例,年龄18 ～81岁,平均（44.6±12.7）岁.所有患者均行体外循环下早期外科治疗,回顾性分析并比较其易感因素、临床表现、超声心动图结果、血培养结果、药敏结果及预后.术后长期随访,终点为死亡或IE复发,随访内容包括评估心功能、有无IE复发等.结果 共分离病原菌65株,主要为链球菌42株、粪肠球菌7株和金葡菌4株.药敏结果显示链球菌对阿奇霉素、克林霉素、红霉素耐药率分别为50.0％、64.3％、66.7％;粪肠球菌对四环素、利福平耐药率均为71.4％;金葡菌对复方新诺明、红霉素耐药率均为50.0％,对青霉素G100％耐药;3种病原菌对利奈唑胺、万古霉素敏感率均＞80.0％.围手术期死亡2例,死因分别为感染性休克和低心排血量综合征.术后随访1～49个月,平均（16.9±10.9）个月,随访57例,失访3例.心功能NY-HA分级Ⅰ级42例,Ⅱ级15例,随访期间均无感染性心内膜炎复发.结论 感染性心内膜炎病原菌以革兰氏阳性菌为主,临床医师需根据病原菌耐药情况合理选择抗菌药,早期手术治疗效果满意.

Objective To analyze the distribution and drug sensitivity of pathogens in blood culture in active infective endocarditis so as to provide the basis for rational use of antibiotics in clinic.To evaluate the impact of early surgical treatment for active infective endocarditis.Methods Blood culture results and clinical data of 62 consecutive patients with active infective endocarditis in Peking Union Medical College Hospital from May 2010 to July 2014 were retrospectively reviewed.All patients underwent early surgical treatment in conventional hypothermic cardiopulmonary bypass.The long-term follow-up after cardiac surgery was conducted.Results 65 trains of pathogenic bacteria were isolated.Streptococcus（n =42）,Enterococcus faecalis（n =7） and Staphylococcus aureus（n =4） were the main three common pathogens.Resistance rates of Streptococcus to azithromycin,clindamycin and erythromycin were 50.0％,64.3％ and 66.7％ respectively.Resistance rates of Enterococcus faecalis to both of tetracycline and rifampicin were 50.0％.Resistance rates of Staphylococcus aureus to both of SMZ-TMP and erythromycin were 50.0％,which to penicillin G were 100％.Sensitive rates of three bacteria to both of linezolid and vancomycin were more than 80.0％.Two cases died from infectious shock and low cardiac output syndrome during the perioperative period.Other 60 patients recovered smoothly.The number of patients recovered with Ⅰ and Ⅱ grade heart function（NYHA） were 42 and 15 respectively during the follow-up period.There was no relapse of endocarditis occurred during the period of follow-up.Conclusion The pathogen of patients with infective endocarditis is mainly Gram-positive bacteria.Clinicians should choose the rational antibacterial drug according to the situation of resistance of pathogenic bacteria.Early surgical treatment can achieve satisfactory effectiveness for active infective endocarditis.