溶血孪生球菌感染性心内膜炎1例报道并文献复习

Endocarditis due to Gemella haemolysans: one case report and literature review

目的了解溶血孪生球菌感染性心内膜炎的临床特征。方法复习国内外发表溶血孪生球菌感染性心内膜炎的文献,结合近期收治的1例病例进行相关分析。结果报道1例溶血孪生球菌致右心感染性心内膜炎。综合文献中该疾病报道和本例溶血孪生球菌感染性心内膜炎共24例,时间跨度从1982-2018年,患者以男性为多,男女比5∶1;以成人为主(95.8%);多有心脏疾病(58.3%)或牙源性疾病(25.0%)基础。感染瓣膜以主动脉瓣为主(50.0%),其次为二尖瓣(41.7%),右心瓣膜较少累及。报道病例抗感染治疗以青霉素类或头孢菌素联合氨基糖苷类最为常见。除1例患者治愈出院后死于未知原因外,本病预后俱佳。结论溶血孪生球菌对常用抗菌药物有较高敏感率,青霉素类或头孢菌素类联合氨基糖苷类治疗该菌引起的感染性心内膜炎可取得较好疗效。但临床已分离到多重耐药株,其耐药机制尚未明确。

Objective To investigate the clinical features of infective endocarditis caused by Gemella haemolysans.Methods One case of endocarditis due to G.haemolysans was described in details.The relevant cases published in literature were also reviewed and discussed.Results One case of right-sided infective endocarditis caused by G.haemolysans was reported in this paper.A total of 24 cases(including this one)of endocarditis due to G.haemolysans were reported from 1982 to 2018.Male to female ratio was 5:1 in these cases.Majority(95.8%)of these patients were adults.Most patients had risk factors of endocarditis,such as history of heart disease(58.3%)or dental disease(25.0%).The major infected valve was aortic valve(50.0%),followed by mitral valve(41.7%),while right-sided infective endocarditis was less common.Penicillins or cephalosporins combined with aminoglycosides were the most common antimicrobial therapies reported.Except for one patient who died of unknown causes after discharge,the prognosis of this disease was good.Conclusions Most Gemella haemolysans strains were highly sensitive to commonly used antimicrobial agents.Literature review suggests that penicillins or cephalosporins combined with aminoglycosides are effective for treatment of the infective endocarditis caused by G.haemolysans.However,multidrug resistant G.haemolysans had been isolated,but its mechanism of resistance has not characterized yet.