感染性心内膜炎患者心脏赘生物培养病原菌分布及耐药性

Distribution and drug resistance of pathogens isolated from cardiac vegetations in patients with infective endocarditis

目的分析感染性心内膜炎患者心脏赘生物培养病原菌分布及其耐药性,为临床合理使用抗菌药物提供参考依据。方法回顾性分析某院2012年7月—2017年7月同期送检心脏赘生物和血培养感染性心内膜炎患者病原菌分布以及赘生物培养病原菌的耐药情况。结果 193例患者心脏赘生物培养阳性率为38.86%(75/193),75例患者赘生物中共分离病原菌82株,其中革兰阳性菌58株(70.73%),革兰阴性菌19株(23.17%),真菌5株(6.10%)。革兰阳性菌对万古霉素仍高度敏感,草绿色链球菌对四环素(37.14%)、克林霉素(51.43%)和红霉素(68.57%)有较高耐药率;葡萄球菌属对红霉素(50.00%)、苯唑西林(60.00%)和青霉素(80.00%)有较高耐药率;肠球菌属对左氧氟沙星、红霉素、环丙沙星和四环素耐药率均≥75.00%;假单胞菌属对环丙沙星(36.36%)、左氧氟沙星(36.36%)、亚胺培南(45.45%)有较强耐药性;苍白杆菌属对β-内酰胺类抗生素耐药率达100.00%;不动杆菌属对所检测抗菌药物均有较高耐药率(均>30.00%)。结论感染性心内膜炎患者心脏赘生物培养病原菌以革兰阳性菌为主,赘生物培养可作为血培养的有效补充与验证,临床治疗应根据药敏结果合理选择抗菌药物。

Objective To analyze the distribution and drug resistance of pathogens isolated from cardiac vegetations in patients with infective endocarditis（ IE）,so as to provide guidance for rational antimicrobial use in clinical treatment.Methods A retrospective analysis was performed on distribution of pathogens isolated from cardiac vege-tations and blood culture,as well as drug resistance of pathogens isolated from cardiac vegetations in patients with IE in a hospital form July2012 to July 2017. Results The positive rate of cardiac vegetation culture from 193 patients was 38. 86%（ 75/193）,82 pathogenic strains were isolated from 75 patients＇ cardiac vegetations,there were 58 strains（ 70.73%） of gram-positive bacteria,19 strains（ 23.17%） of gram-negative bacteria,and 5 strains（ 6.10%） of fungi. Gram-positive bacteria were still highly sensitive to vancomycin,Streptococcus viridans had higher resistance rates to tetracycline（ 37. 14%）,clindamycin（ 51.43%）,and erythromycin（ 68.57%）; Staphylococcus spp. showed higher resistance rates to erythromycin（ 50.00%）,oxacillin（ 60.00%）,and penicillin（ 80.00%）; resistance rates of Enterococcus spp. to levofloxacin,erythromycin,ciprofloxacin,and tetracycline were all≥75. 00%; Pseudomonas spp. were highly resistant to ciprofloxacin（ 36. 36%）,levofloxacin（ 36.36%）,and imipenem（ 45.45%）; drug resistance rates of Ochrobactrum spp. to β-lactam antibiotics were up to 100.00%; Acinetobacter spp. had high resistance rates to all detected antimicrobial agents（ all30.00%）. Conclusion Pathogens isolated from cardiac vegetations in patients with IE are mainly gram-positive bacteria,cardiac vegetation culture can serve as an effective supplement and validation for blood culture,antimicrobial agents should be selected rationally in the clinical treatment according to antimicrobial susceptibility testing result.