某三甲医院感染性心内膜炎病原菌及耐药性分析

Analysis on pathogenic bacteria and drug resistance of infective endocarditis in a third grade hospital

目的探讨感染性心内膜炎病原菌及耐药性,为临床医师合理应用抗菌药物提供参考。方法选取2014年6月1日~2019年5月31日某三甲医院感染性心内膜炎住院患者107例进行回顾性分析,选出行血细菌培养及药物敏感试验的79例病例,对临床资料中病原菌构成和耐药性进行分布。结果107例感染性心内膜炎患者共检出非重复病原菌79株,革兰阳性菌75株(占94.94%),其中链球菌属细菌31株(占39.24%),金黄色葡萄球菌22株(占27.85%),革兰阴性菌4株(占5.06%),未检测到真菌感染。链球菌仍是最常见的致病菌(39.24%),耐药性分析显示:链球菌属细菌对青霉素的耐药率为90.32%;22株金黄色葡萄球菌属细菌有20株对青霉素耐药,对苯唑西林的耐药率为81.82%;但对特殊使用级抗菌药物无耐药,如万古霉素、亚胺培南、利奈唑胺等敏感。结论感染性心内膜炎的病原菌以革兰阳性菌为主,链球菌属仍是最常见的,对社区常用抗菌药物耐药率高。革兰阳性球菌均对青霉素普遍呈现耐药。临床应结合当地病原学资料先期经验性选择抗菌药物,并根据药敏实验结果及时调整用药方案,以确保抗感染治疗的有效性和安全性。

Objective To explore the pathogenic bacteria and drug resistance of infective endocarditis,and to provide references for clinicians to apply antibiotics rationally.Methods A total of 107 inpatients with infective endocarditis(infective endocarditis)in a third-class hospital from June 1,2014 to May 31,2019 were selected for retrospective analysis,and 79 cases were selected for blood bacterial culture and drug sensitivity test.The pathogenic bacteria composition and drug resistance distribution in clinical data were analyzed.Results In 107 patients with infective endocarditis,79 strains of non-duplicative pathogens were detected,including 75 strains of gram-positive bacteria(94.94%),including 31 strains of streptococcus(accounting for 39.24%),22 strains of Staphylococcus aureus(accounting for 27.85%),and 4 strains of gram-negative bacteria(accounting for 5.06%),no cases of fungal infection were detected.Streptococcus was still the most common pathogenic bacteria(39.24%).Drug resistance analysis was showed that the drug resistance rate of Streptococcus bacteria to Penicillin was 90.32%.Of the 22 strains of Staphylococcus bacteria,20 strains were resistant to Penicillin,and the drug resistance rate of Benzoxicillin was 81.82%.However,it was sensitive to antibiotics of special use grade,such as Vancomycin,Imipenem and Linezolid,and had no resistance.Conclusion The pathogenic bacteria of infective endocarditis are mainly gram-positive bacteria,and Streptococcus is still the most common.Gram-positive cocci are generally resistant to Penicillin.In order to ensure the efficacy and safety of antiinfective treatment,antibacterials should be selected empirically in combination with the local etiological data,and the drug regimen should be adjusted in time according to the results of drug susceptibility test.