医院感染性心内膜炎患者的病原菌分布及炎症相关指标和危险因素分析

Analysis of pathogen distribution, inflammation-related indicators, and risk factors in patients with nosocomial infective endocarditis

目的探讨医院感染性心内膜炎患者病原菌分布、炎症相关指标及危险因素。方法选取278例医院感染性心内膜炎患者,采血,进行病原菌培养及耐药性检测;采用ELISA法检测相关血液炎症指标,对比分析血培养阳性患者和阴性患者炎症因子水平及相关炎症指标的差异性。收集患者临床资料,分析影响医院感染性心内膜炎预后的危险因素。结果血培养标本共278份,病原菌阳性率为71.22%。检出病原菌330株,其中革兰阳性菌224株(67.88%),革兰阴性菌90株(27.27%),真菌16株(4.85%)。常见病原菌包括链球菌属细菌(35.76%)、金黄色葡萄球菌(17.58%)、大肠埃希菌(11.82%)、嗜麦芽寡养单胞菌(6.67%)。链球菌属细菌及金黄色葡萄球菌对青霉素G的耐药率均超过90%,对克林霉素、替考拉宁、利奈唑胺的耐药率均在5%以下。大肠埃希菌和嗜麦芽寡养单胞菌对庆大霉素的耐药率均超过50%,对阿米卡星、亚胺培南、美罗培南的耐药性均在10%以下。血培养阳性患者的白细胞计数(WBC)为(18.15±7.23)×10^9/L,淋巴细胞计数(LY)为(17.37±7.15)×10^9/L,中性粒细胞计数(NEUT)为(21.17±9.32)×10^9/L,红细胞沉降率(ESR)为(68.04±12.71)mm/h,C反应蛋白(CRP)为(49.47±15.29)mg/L,与血培养阴性患者比较差异均有统计学意义(均P<0.05)。多因素Logistic回归分析显示,血红蛋白<90 g/L是影响医院感染性心内膜炎预后的危险因素,手术治疗是影响医院感染性心内膜炎预后的保护因素(P<0.05)。结论革兰阳性菌是医院感染性心内膜炎的主要病原菌,且血培养阳性患者具有更高的炎症指标。手术治疗以及血红蛋白水平的提高有助于改善患者的预后。

Objective To investigate the pathogen distribution, inflammation-related indicators, and risk factors in patients with nosocomial infective endocarditis. Methods Subjects were 278 patients with nosocomial infective endocarditis, and the distribution of pathogens and drug resistance of main pathogens were analyzed. Inflammation-related indicators in patients with positive blood cultures and those with negative blood cultures were compared. Risk factors affecting the prognosis of nosocomial infective endocarditis were analyzed. Results Two hundred and seventy-eight blood culture specimens were examined in this study, and pathogens were found in 71.22%. Three hundred and thirty pathogens were detected, including 224 strains of Gram-positive bacteria(67.88%), 90 strains of Gram-negative bacteria(27.27%), and 16 strains of fungi(4.85%). The common pathogens were Streptococcus(35.76%), Staphylococcus aureus(17.58%), Escherichia coli(11.82%), and Stenotrophomonas maltophilia(6.67%). The resistance of Streptococcus and S. aureus to penicillin G was 94.07% and 91.38%, their resistance to clarithromycin was 3.39% and 0.00%, their resistance to teicoplanin was 4.24% and 0.00%, and their resistance to linezolid was 0.00% and 0.00%. The resistance of Escherichia coli and S. maltophilia to gentamicin was 53.85% and 54.55%, their resistance to amikacin was 7.69% and 9.09%, and their resistance to imipenem was 0.00% and 0.00%. The white blood cell count(WBC) in patients with positive blood cultures was 18.15±7.23×10^9/L, the lymphocyte count(LY) was 17.37±7.15×10^9/L, the neutrophil count(NEUT) was 21.17±9.32×10^9/L, the erythrocyte sedimentation rate(ESR) was 68.04±12.71 mm/h, and the C-reactive protein(CRP) level was 49.47±15.29 mg/L;these inflammatory indicators were all significantly higher than those in patients with negative blood cultures(P<0.05). Hemoglobin < 90 g/L was a risk factor affecting the prognosis of nosocomial infective endocarditis, and surgery was a protective factor affecting the prognosis of nosocomial infective endocarditis(P<0.05). Conclusion Gram-positive bacteria were the main pathogens causing nosocomial infective endocarditis, and patients with positive blood cultures had higher levels of inflammatory indicators. Surgery and improvement of hemoglobin levels should help to improve patient prognosis.