医院相关性感染性心内膜炎的影响因素分析及预防对策研究

Influencing factors for hospital-associated infective endocarditis and prevention countermeasures

目的探讨医院相关性感染性心内膜炎的影响因素及预防对策,以降低医院相关性感染性心内膜炎感染率。方法选择2007年1月-2015年1月在医院接受治疗的229例医院相关性感染性心内膜炎患者,采集患者血液标本进行细菌培养、鉴定及药敏试验,并对医院相关性感染性心内膜炎的影响因素进行统计分析。结果共送检标本229份,其中阳性标本163份,阳性率为71.18%;共分离出病原菌273株,其中革兰阳性菌185株占67.76%,革兰阴性菌74株占27.11%,真菌14株占5.13%;主要革兰阳性菌对青霉素、环丙沙星耐药率均>50%,而对利奈唑胺、替考拉宁非常敏感;主要革兰阴性菌对庆大霉素具有较高的耐药率,均>50%;而对亚胺培南、美罗培南非常敏感,耐药率均<12%;大肠埃希菌及嗜麦芽寡养单胞菌对阿米卡星的耐药率均<12%;相关因素分析结果显示,年龄、广谱抗菌药物使用、风湿性瓣膜心脏病、先天性心脏病、非风湿性瓣膜心脏病、缺血性心脏病、心外科手术、血液透析是医院相关性感染性心内膜炎的影响因素(P<0.05)。结论医院相关性感染性心内膜炎的影响因素为年龄、广谱抗菌药物使用、风湿性瓣膜心脏病、先天性心脏病、非风湿性瓣膜心脏病、缺血性心脏病、心外科手术、血液透析,临床应根据影响因素采取相应的预防措施,以降低医院相关性感染性心内膜炎的发生率。

OBJECTIVE To explore the influencing factors for hospital-associated infective endocarditis and put forward the prevention countermeasures so as to reduce the incidence of hospital-associated infective endocarditis.METHODS A total of 229 patients with hospital-associated infective endocarditis who were treated in the hospital from Jan 2007 to Jan 2015 were enrolled in the study,the blood specimens of the patients were collected for bacterial culture,identification and drug susceptibility testing,and the influencing factors for the hospital-associated endocarditis were statistically analyzed.RESULTS Of totally 229 submitted specimens,163 were positive,with the positive rate 71.18%.A total of 273 strains of pathogens were isolated,of which 185（67.76%）were gram-positive bacteria,74（27.11%）were gram-negative bacteria,and 14（5.13%）were fungi.The drug resistance rates of the main gram-positive bacteria to penicillin and ciprofloxacin were more than 50%,however,the strains were highly susceptible to linezolid and teicoplanin.The drug resistance rate of the main gram-negative bacteria to gentamicin was more than 50%,however,the drug resistance rates to imipenem and meropenem were less than 12%.The drug resistance rates of Escherichia coli and Stenotrophomonas maltophilia strains to amikacin were less than 12%.The result of analysis of the related factors showed that the influencing factors for the hospital-associated infective endocarditis included the age,use of broad spectrum antibiotics,rheumatic valvular heart disease,congenital heart disease,non-rheumatic valvular heart disease,ischemic heart disease,cardiac surgery and hemodialysis（P〈0.05）.CONCLUSION The influencing factors for the hospital-associated infective endocarditis include the age,use of broad spectrum antibiotics,rheumatic valvular heart disease,congenital heart disease,non-rheumatic valvular heart disease,ischemic heart disease,cardiac surgery and hemodialysis.It is necessary for the hospital to take the targeted prevention measures according to the influencing factors so as to reduce the incidence of hospital-associated infective endocarditis.