心脏瓣膜置换术后肺部感染病原菌与耐药性研究

Pathogens and drug resistance of postoperative pulmonary infection in patients undergoing cardiac valve replacement

目的探索心脏瓣膜置换术患者肺部感染的病原菌与耐药率。方法回顾性分析2016年1月-2018年1月于四川省人民医院接受治疗的304例心脏瓣膜置换术后肺部感染患者临床资料,对患者血液及咳痰进行病原菌培养及鉴定,并对不同常用抗菌药物进行耐药率分析。结果304例肺部感染患者共检出292株病原菌,其中革兰阴性菌196株,占67.12%,以铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌为主;革兰阳性菌88株,占30.14%,以金黄色葡萄球菌、表皮葡萄球菌为主;真菌8株,占2.74%。主要革兰阴性菌中铜绿假单胞菌对甲氧苄啶、环丙沙星、头孢曲松钠耐药率分别为73.91%、50.00%、80.43%;肺炎克雷伯菌对甲氧苄啶、环丙沙星、头孢吡肟耐药率分别为64.29%、57.14%、51.79%;大肠埃希菌对甲氧苄啶、环丙沙星、头孢吡肟耐药率分别为83.78%、59.46%、58.11%。主要革兰阳性菌中金黄色葡萄球菌对甲氧苄啶、红霉素、左氧氟沙星、哌拉西林、青霉素G耐药率较高;表皮葡萄球菌对红霉素、左氧氟沙星、哌拉西林、青霉素G等耐药率较高。结论心脏瓣膜置换术患者肺部感染以革兰阴性菌为主,主要革兰阴性菌、革兰阳性菌对甲氧苄啶、环丙沙星、头孢曲松钠、头孢吡肟、红霉素、左氧氟沙星、哌拉西林、青霉素G等常用抗菌药物耐药性较高,医师治疗时应选择耐药性较低的抗菌药物进行治疗。

OBJECTIVE To explore the pathogens and drug resistance of pulmonary infection in patients undergoing cardiac valve replacement.METHODS The clinical data of 304 patients with pulmonary infection after heart valve replacement in Sichuan Provincial People’s Hospital from Jan.2016 to Jan.2018 were analyzed retrospectively.Pathogens were cultured and identified from blood and expectoration of the patients,and the drug resistance against different antibiotics was analyzed.RESULTS Totally 292 strains of pathogens were detected in the 304 cases of pulmonary infection,of which 196 strains were Gram-negative bacteria,accounting for 67.12%,dominated by Pseudomonas aeruginosa,Klebsiella pneumoniae and Escherichia coli,88 strains were Gram-positive bacteria,accounting for 30.14%,dominated by Staphylococcus aureus and Staphylococcus epidermidis,and 8 strains were fungi,accounting for 2.74%.In the main Gram-negative bacteria,the resistance rates of P aeruginosa to trimethoprim,ciprofloxacin and ceftriaxone were 73.91%,50.00%and 80.43%,respectively,the resistance rates of K pneumoniae to trimethoprim,ciprofloxacin,and cefepime were 64.29%,57.14%,51.79%,respectively,and the resistance rates of E coli to trimethoprim,ciprofloxacin and ceftriaxone were 83.78%,59.46%and 58.11%respectively.In the main Gram-positive bacteria,S aureus had relatively high resistance to trimethoprim,erythromycin,levofloxacin,piperacillin and penicillin G,whereas S epidermidis had relatively high resistance to erythromycin,levofloxacin,piperacillin and penicillin G.CONCLUSION The main pathogens of pulmonary infection in patients undergoing cardiac valve replacement are Gram-negative bacteria.The main Gram-negative bacteria and Gram-positive bacteria have relatively high resistance to trimethoprim,ciprofloxacin,ceftriaxone,ceftriaxone,erythromycin,levofloxacin,piperacillin and penicillin G,and sensitive antimicrobial agents should be selected in the treatment of the patients.