感染性心内膜炎患者细菌培养和抗菌药物选用的临床研究

Clinical study on bacterial culture and antimicrobial drug selection in patients with infective endocarditis

目的了解有无心脏基础疾病的感染性心内膜炎患者致病菌感染谱和耐药性的变化,为临床经验性使用抗菌药物提供依据。方法选择2018年1月至2020年12月在山东第一医科大学第二附属医院和济南市第五人民医院住院的感染性心内膜炎患者171例为研究对象,按有无心脏基础性疾病,分成A组(无心脏基础性疾病)和B组(有心脏基础性疾病),分别进行静脉血培养,分离菌株,分析病原菌分布;分析主要革兰阳性菌和革兰阴性菌耐药性,比较两组的差异性。结果A组83例患者中检出病原菌103株,其中革兰阳性菌主要为草绿色链球菌、金黄色葡萄球菌,革兰阴性菌主要为大肠埃希菌、鲍氏不动杆菌;革兰阳性菌占比高于革兰阴性菌株、真菌,革兰阴性菌株高于真菌,差异有统计学意义(P<0.05)。B组88例患者中检出病原菌99株,其中革兰阳性菌主要为草绿色链球菌、金黄色葡萄球菌,革兰阴性主要为大肠埃希菌、鲍氏不动杆菌,革兰阳性菌占比高于革兰阴性菌株、真菌,革兰阴性菌株高于真菌,差异有统计学意义(P<0.05)。两组患者主要致病菌是草绿色链球菌和金黄色葡萄球,A组革兰阴性菌和真菌显著高于B组,革兰阳性菌显著低于B组,差异有统计学意义(P<0.05)。药敏结果显示两组草绿色链球菌对青霉素耐药率均较高,对左氧氟沙星、利福平耐药率均较低,对莫西沙星、万古霉素、利奈唑胺均不耐药;两组金黄色葡萄球菌对青霉素、氨苄西林耐药率均较高,对左氧氟沙星、万古霉素耐药率差别较大,差异无统计学意义(P>0.05),对利奈唑胺均不耐药;两组大肠埃希菌对头孢唑林、头孢曲松、头孢哌酮耐药率均较高,对庆大霉素、阿米卡星耐药率差别较大,差异无统计学意义(P>0.05),对左氧氟沙星、环丙沙星、美罗培南、亚胺培南均不耐药;鲍氏不动杆菌对头孢唑林、头孢曲松、头孢哌酮、哌拉西林耐药率均较高,对环丙沙星、阿米卡星耐药率均较低,对左氧氟沙星、美罗培南差异较大,差异无统计学意义(P>0.05),对亚胺培南均不耐药。结论了解有无心脏基础性疾病,初步判断感染性心内膜炎患者致病菌感染谱分布、掌握细菌耐药的最新动态变迁,指导临床合理应用抗菌药物。

Objective To understand the changes in the infection spectrum and drug resistance of pathogenic bacteria in patients with infective endocarditis with or without underlying cardiac disease,so as to provide a basis for the empirical clinical use of antimicrobial drugs.Methods A total of 171 patients with infective endocarditis hospitalized in the Second Affiliated Hospital of Shandong First Medical University and the Fifth People's Hospital of Ji'nan City in Shandong Province from January 2018 to December 2020 were divided into group A(without underlying cardiac disease)and group B(with underlying cardiac disease)according to the presence or absence of underlying cardiac disease.The venous blood of the two groups of patients was collected and cultured,followed by isolating strains and analyzing the distribution of pathogenic bacteria.The drug resistance of major Gram-positive and Gramnegative bacteria in both groups was analyzed,and the differences between the two groups were compared.Results In group A,103 pathogenic strains were detected in 83 patients,among which Gram-positive bacteria were mainly Streptococcus viridans and Staphylococcus aureus,and Gram-negative bacteria were mainly Escherichia coli and Acinetobacter baumannii.The proportion of Gram-positive strains was higher than that of Gram-negative strains and fungi,and the proportion of Gram-negative strains was higher than that of fungi,with statistically significant differences(P<0.05).A total of 99 pathogenic strains were detected in 88 patients in group B,among which Gram-positive bacteria were mainly Streptococcus viridans and Staphylococcus aureus,Gram-negative bacteria were mainly Escherichia coli and Acinetobacter baumannii.The proportion of Gram-positive strains was higher than that of Gram-negative strains and fungi,and the proportion of Gram-negative strains was higher than that of fungi,with statistically significant differences(P<0.05).The main pathogenic bacteria in both groups were Streptococcus viridans and Staphylococcus aureus,and the numbers of Gram-negative bacteria and fungi in group A were significantly higher than those in group B,while the number of the Gram-positive bacteria in group A was significantly lower than that in group B,with statistically significant differences(P<0.05).The drug sensitivity results showed that Streptococcus viridans in both groups had high resistance rate to penicillin,low resistance rate to levofloxacin and rifampicin,and no resistance to moxifloxacin,vancomycin and linezolid.The Staphylococcus aureus in both groups had high resistance rate to penicillin and ampicillin,and had a great difference in resistance rate to levofloxacin and vancomycin,but without statistically significant difference between the two groups(P>0.05).Meanwhile,the Staphylococcus aureus in both groups had no resistance to linezolid.The Escherichia coli in both groups had high resistance rate to cefazolin,ceftriaxone and cefoperazone,and had a great difference in resistance rate to gentamicin and amikacin,but without statistically significant difference between the two groups(P>0.05).Meanwhile,the Escherichia coli in both groups had no resistance to levofloxacin,ciprofloxacin,meropenem and imipenem.The Acinetobacter baumannii in both groups had high resistance rate to cefazolin,ceftriaxone,cefoperazone and piperacillin,low resistance rate to ciprofloxacin and amikacin,and had a great difference in resistance rate to levofloxacin and meropenem,but without statistically significant difference between the two groups(P>0.05).Meanwhile,the Acinetobacter baumannii had no resistance to imipenem.Conclusion It is necessary to understand the presence of underlying cardiac diseases and preliminarily determine the distribution of the infection spectrum of pathogenic bacteria in patients with infective endocarditis,as well as grasp the latest dynamic changes in bacterial resistance,so as to guide the rational application of antimicrobial drugs in clinic.