感染性心内膜炎患者抗菌药物使用频度及草绿色链球菌耐药率分析

Frequency of Use of Antibiotics and the Drug Resistance Rate of Streptococcus Viridans in Patients with Infective Endocarditis

背景感染性心内膜炎是一种常见的感染性疾病,对患者威胁较大,多由各种病原菌引起,其中草绿色链球菌是常见的一种,而了解抗菌药物的使用频度及分析相关病原菌耐药率有利于患者的高效治疗。目的分析感染性心内膜炎患者抗菌药物使用频度及草绿色链球菌耐药率。方法选取2019年11月-2020年11月蕲春县李时珍医院收治的感染性心内膜炎患者125例为研究对象。统计患者抗菌药物使用情况,计算抗菌药物使用频度,对患者病原菌进行分离与鉴定,同时检测草绿色链球菌对常用的16种抗菌药物的耐药率。结果 125例患者中有105例使用抗菌药物,使用率为84.0%,使用种类有23种,共使用195例次,其中非限制级抗菌药物使用96例次(49.2%)、限制级抗菌药物使用92例次(47.2%)、特殊级抗菌药物使用7例次(3.6%)。使用频度前7位的抗菌药物分别为头孢哌酮/舒巴坦(1815.3)、呱拉西林/他唑巴坦(740.9)、左氧氟沙星(656.8)、头孢替安(163.1)、头孢呋辛(136.9)、氨曲南(126.8)、复方新诺明(110.9)。共筛出236株病原菌,其中革兰阳性菌184株(78.0%),革兰阴性菌42株(17.8%),真菌10株(4.2%)。共分离出42株草绿色链球菌。草绿色链球菌总耐药率前5位药物从高到低依次为氨苄西林/舒巴坦(54.8%)、头孢曲松(52.4%)、复方新诺明(45.2%)、头孢替坦(21.4%)、环丙沙星(21.4%),但对亚胺培南、厄他培南、阿米卡星不耐药。结论感染性心内膜炎患者抗菌药物使用率较高,主要为非限制级抗菌药物和限制级抗菌药物,而头孢哌酮/舒巴坦的使用频度最高;感染性心内膜炎患者草绿色链球菌耐药率最高的药物为氨苄西林/舒巴坦和头孢曲松,但对亚胺培南、厄他培南、阿米卡星不耐药。

Background Infective endocarditis is a common infectious disease,which is a great threat to patients and is mostly caused by various pathogens,among which Streptococcus viridis is a common one.Understanding the frequency of use of antibiotics and analyzing the drug resistance rate of related pathogens are beneficial to the efficient treatment of patients.Objective To analyze the frequency of use of antibiotics and the drug resistance rate of Streptococcus viridans in patients with infective endocarditis.Methods A total of 125 patients with infective endocarditis treated in Li Shizhen Hospital of Qichun County from November 2019 to November 2020 were selected as the research subjects.The use of antibiotics of patients was counted,the frequency of use of antibiotics was calculated,the pathogenic bacteria were isolated and identified,and the resistance rate of Streptococcus viridis to 16 kinds of antibiotics was detected.Results Among the 125 patients,105 cases used antibiotics,the utilization rate was 84.0%,and 23 kinds of antibiotics were used,195 times in total,of which 96 times(49.2%)were used for unrestricted antibiotics,92 times(47.2%)were used for restricted antibiotics,and 7 times(3.6%)were used for special class antibiotics.The top 7 antibiotics used were cefoperazone/sulbactam(1815.3),piperacillin/tazobactam(740.9),levofloxacin(656.8),cefotiam(163.1),cefuroxime(136.9),aztreonam(126.8)and sulfamethoxazole(110.9).A total of 236 strains of pathogenic bacteria were screened,including 184 strains of Gram-positive bacteria(78.0%),42 strains of Gram-negative bacteria(17.8%)and 10 strains of fungi(4.2%).A total of 42 strains of Streptococcus viridis were isolated.The top 5 drug resistance rates of Streptococcus viridis from high to low were ampicillin/sulbactam(54.8%),ceftriaxone(52.4%),sulfamethoxazole(45.2%),cefotitan(21.4%)and ciprofloxacin(21.4%),but they were not resistant to imipenem,ertapenem and amikacin.Conclusion The use rate of antibacterial drugs in patients with infective endocarditis is relatively high,mainly non-restricted antibacterial drugs and estricted antibacterial drugs,while cefoperazone/sulbactam is used most frequently.The drug with the highest drug resistance rate of Streptococcus viridans in patients with infective endocarditis is ampicillin/sulbactam and ceftriaxone,but Streptococcus viridans is not resistant to imipenem,ertapenem,and amikacin.