感染性心内膜炎病因与病原学的相关性分析

Analysis of the Relationship Between Etiology and Pathogen in Patients with Infective Dndocarditis

目的分析感染性心内膜炎(infective endocarditis,IE)病因与病原学的相关性。方法回顾性分析北京大学第一医院2010年1月1日—2016年6月30日收治的IE患者临床资料,比较左右心瓣膜病变、有无基础心脏病、健康护理机构相关性IE(healthcare associated infective endocarditis,HCA-IE)与社区获得性IE(community acquired infective endocarditis,CA-IE)患者的病原学分布以及不同病因患者的预后。结果 66例IE排在前3位的病原菌是链球菌属、葡萄球菌属、肠球菌属。左心瓣膜病变59例,病原学分布居首位的是链球菌属,右心瓣膜病变7例,病原学分布居首位的是葡萄球菌属,二者病原学分布比较差异无统计学意义(P=0.292);有和无基础心脏病IE病原学分布均以链球菌属居首位,病原学分布比较差异无统计学意义(P=0.704);HCA-IE病原学分布以葡萄球菌属居首位,CA-IE病原学分布以链球菌属居首位,二者病原学分布比较差异有统计学意义(P=0.001);有基础心脏病和无基础心脏病IE患者病死率比较差异无统计学意义(P=0.681)。结论不同病因导致的IE病原学分布不同,分析患者的病因有利于预测病原学分布及早期准确应用抗菌药物进行抗感染治疗。

Objective To investigate the relationship between etiology and pathogens of infective endocarditis(IE).Methods Medical records from patients(n=66)diagnosed with IE in the First Hospital of Peking University from January 1st 2010 to June 30th 2016 were retrospectively reviewed.We evaluated pathogen distribution between patients with left and right valve IE,with and without previous heart disorders,with healthcare associated IE(HCA-IE)and community acquired IE(CA-IE),respectively.We also compared the prognosis of different patient.Results Streptococcus,staphylococcus and enterococcus were the most common pathogens in blood culture of IE patients.Streptococcus was the most common one in IE with left valves(n=59),as with staphylococcus in IE with right valves(n=7).No significant differences were observed in distribution of pathogen in both(P=0.292).And streptococcus was the most common pathogen in IE patients regardless of previous heart disorders,showing no significant difference(P=0.704).Staphylococcus was the most common pathogen in HCA-IE,as with streptococcus in CA-IE.Nevertheless,distribution of pathogens in patients with HCA-IE or CA-IE differed significantly(P=0.001).There was no significant difference int mortality rate in IE patients with or without previous heart disorders(P=0.681).Conclusion Different etiologies contributes to differences of pathogen distribution in IE patients.Analysis of etiology is conductive to the prediction of pathogen distribution,which can facilitate appropriate use of antimicrobial drugs for anti-infective therapy at early stage.