202例感染性心内膜炎病原学特征及预后影响因素

Etiological features of 202 patients with infective endocarditis and the risk factors affecting patient′s prognosis in hospital

目的探讨感染性心内膜炎(IE)患者病原学特征及不良预后影响因素。方法收集2010年1月-2020年1月南阳医学高等专科学校第一附属医院心血管内科收治的202例IE患者临床资料,分析IE患者病原学分布与耐药特点、临床结局的影响因素。结果202例IE患者血培养阳性126例,血培养阳性率为62.38%,分离鉴定病原菌158株,其中革兰阳性菌129株、革兰阴性菌26株、真菌3株;草绿色链球菌对美罗培南、亚胺培南、万古霉素无耐药性,对红霉素、青霉素耐药率分别为65.52%、37.93%;多因素Logistic回归分析结果显示,血红蛋白(≤90 g/L)、心功能Ⅲ~Ⅳ级、风湿性心脏病以及栓塞是IE患者不良预后的危险因素(P<0.05),手术介入治疗是IE患者不良预后的保护因素(P<0.05)。结论IE感染病原菌以革兰阳性菌种为主,对美罗培南、亚胺培南、万古霉素敏感,严重贫血、心功能Ⅲ~Ⅳ级、风湿性心脏病、栓塞可增加IE患者不良预后风险。

OBJECTIVE To explore the etiological characteristics and risk factors for the poor prognosis in patients with infective endocarditis(IE).METHODS The clinical data of 202 IE patients admitted to Cardiovascular Department of the First Affiliated Hospital of Nanyang Medical College between Jan 2010 and Jan 2020 were enrolled.The etiological distribution,drug resistance features and influencing factors for clinical outcomes were analyzed.RESULTS 129 cases in 202 IE patients were positive in blood culture,with the positive rate of 62.38%.158 strains of pathogens were identified,including 129 strains of Gram-positive bacteria,26 strains of Gram-negative bacteria,and 3 strains of fungi.There was no resistance of Streptococcus viridans to meropenem,imipenem and vancomycin,and the resistance rates to erythromycin and penicillin were 65.52%and 37.93%,respectively.Multivariate Logistic regression analysis showed that hemoglobin(≤90 g/L),heart functionⅢ,rheumatic heart disease and embolism were risk factors for poor prognosis of IE patients(P<0.05),and surgical intervention was a protective factor for poor prognosis of IE patients(P<0.05).CONCLUSION The pathogens of IE infection are mainly Gram-positive bacteria,which are sensitive to meropenem,imipenem and vancomycin.Severe anemia,Ⅲ~IV grade heart function,rheumatic heart disease and embolism can increase the risk of poor prognosis in IE patients.