感染性心内膜炎病原菌及死亡危险因素分析

Analysis of Pathogens and Death Factors of Infective Endocarditis

目的评估感染性心内膜炎(infective endocaditis,IE)病原菌敏感度及其院内死亡风险。方法回顾性分析149例IE患者存活组与死亡组临床特点,探索病原菌构成、药敏及死亡危险因素。结果149例IE患者菌株阳性率69.1%,链球菌占比最高(52.3%),万古霉素、头孢曲松、利奈唑胺、左氧氟沙星、青霉素、氨苄西林、美罗培南敏感率均>50.0%,红霉素耐药达60.9%。院内病死率12.8%,女性、肾功能不全、心力衰竭(heart failure,HF)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)<0.845mmol/L是住院死亡独立危险因素(P<0.05)。结论链球菌属性IE常见,万古霉素、头孢曲松、利奈唑胺、左氧氟沙星高度敏感。女性、合并肾功能不全、并发HF、HDL-C降低的IE患者院内死亡风险高。

Objective To evaluate the pathogen sensitivity and in-hospital death risk of infective endocarditis(IE).Methods The clinical characteristics of survival group and death group in 149 patients of IE were analyzed retrospectively,and explore the composition of pathogens,drug sensitivity and risk factors of death.Results The positive detection rate of pathogenic microorganisms in 149 patients of IE was 69.1%,and the proportion of Streptococcus was the highest(52.3%).The sensitive rates of vancomycin,ceftriaxone,linezolid,levofloxacin,penicillin,ampicillin and meropenem were more than 50%,and the resistance rate of erythromycin was 60.9%.The in-hospital mortality was 12.8%.Female,renal insufficiency,HF and HDL-C<0.845mmol/L were independent risk factors for in-hospital death(P<0.05).Conclusion Streptococcus is the most common pathogen of IE.Vancomycin,ceftriaxone,linezolid and levofloxacin are highly sensitive.High risk of in-hospital death in IE patients with female,renal insufficiency,HF and HDL-C reduction.