感染性心内膜炎血培养阳性患者的临床研究

Clinical study on blood culture positive patients with infective endocarditis

目的探讨感染性心内膜炎血培养阳性患者的临床诊治特点,以指导临床预防及控制疾病。方法将2004年12月-2014年12月的182例感染性心内膜炎患者按血培养结果分为阳性组80例、阴性组102例,分析阳性患者临床表现、病原菌分布及耐药性;统计患者预后。结果两组患者基础病因均以先天性心脏病为主,主要临床特征均为发热,组间比较差异无统计学意义,阳性组患者心脏杂音出现较少、贫血出现较多,组间比较差异有统计学意义(P<0.05);阳性组患者肾功能不全、脏器栓塞出现率较高,组间比较差异有统计学意义(P<0.05);两组患者白细胞总数、血沉、C-反应蛋白比较,差异均有统计学意义(P<0.05);阳性组患者病原菌以酿脓链球菌、金黄色葡萄球菌、粪肠球菌为主,分别占50.0%、22.5%及11.3%,其对青霉素、红霉素、克林霉素均表现出较高的耐药性;阳性组患者死亡7例,病死率达8.8%;糖尿病史、致病菌类型、心脏感染部位为死亡独立危险因素(P<0.05)。结论感染性心内膜炎血培养阳性临床表现缺乏特异性,行实验室检查有助于明确病因。

OBJECTIVE To investigate the clinical diagnostic features of blood culture positive patients with infec‐tive endocarditis so as to guide clinical prevention and control of the disease .METHODS From Dec .2004 to Dec . 2014 ,totally 182 cases of infective endocarditis patients were divided into two groups according to the results of blood culture .The positive group had 80 cases and the negative group had 102 cases .The clinical manifestations , pathogenic distribution and drug resistance of the positive group were analyzed .RESULTS The basic disease of the two groups was mainly congenital heart disease ,manifested as fever clinically .The differences were not signifi‐cant .Patients in positive group appeared less cardiac souffle but more anemias .The differences were significant （P〈0 .05） .More patients in the positive group suffered renal failure and organ embolism .The differences were significant （P〈0 .05） .Differences of total white blood cells ,ESR and C‐reactive protein were significant （P〈0 . 05） .Streptococcus pyogenes ,Staphylococcus aureus ,and Enterococcus f aecalis were the major pathogens in posi‐tive group ,accounting for 50 .0% ,22 .5% and 11 .3% respectively .They were all resistant to penicillin ,erythro‐mycin and clindamycin .Totally 7 cases in the positive group died and the death rate was 8 .8% .History of diabe‐tes ,pathogen types ,heart infection sites were independent risk factors for death （P〈0 .05） .CONCLUSION Blood culture positive patients with infective endocarditis proved to lack specificity in clinical manifestations .The Labo‐ratory tests can help to find the cause of the disease .