感染性心内膜炎患者病原菌分布及耐药性分析

Analysis of Pathogenic Bacteria Distribution and Drug Resistance in Patients with Infective Endocarditis

目的:分析感染性心内膜炎(Infective Endocarditis, IE)住院患者感染病原菌分布及耐药性,为临床合理选择抗菌药物提供依据。方法:选取2020年2月~2023年1月在济宁医学院附属医院确诊的感染性心内膜炎住院患者160例为研究对象,按照《全国临床检验操作规程》标准分离、鉴定细菌,K-B纸片法进行药敏试验,收集并统计医院感染情况,对感染患者病原菌的分布及耐药情况进行回顾性分析。结果:160例IE患者血标本共分离出172株病原菌,其中革兰阳性菌116株(占67.44%),主要为草绿色链球菌、金黄色葡萄球菌、表皮葡萄球菌;革兰阴性菌52株(占30.23%),主要为肺炎克雷伯菌、嗜麦芽窄食单胞菌,真菌4株。草绿色链球菌对氯霉素耐药率最高为90.91%,金黄色葡萄球菌对青霉素耐药率较高为100.00%,未见对万古霉素和利奈唑胺耐药株。肺炎克雷伯菌对氨苄西林耐药率最高为78.23%,嗜麦芽窄食单胞菌对克拉霉素和左氧氟沙星均无耐药菌株,该菌对头孢曲松耐药率较高为86.67%,对庆大霉素和环丙沙星相对较敏感,耐药率仅为6.67%和13.33%。结论:感染性心内膜炎感染的病原菌以革兰阳性球菌为主,对常用的抗菌药物耐药率较高,应根据感染性心内膜炎病原菌的分布和耐药性合理选用抗菌药,对提高患者生存率具有重大意义。

Objective: To analyze the distribution and drug resistance of infective pathogens in hospitalized pa-tients with infective endocarditis, and provide basis for rational selection of clinical antibiotics. Methods: 160 inpatients with infective endocarditis diagnosed in Affiliated Hospital of Jining Medi-cal College from February 2020 to January 2023 were selected as the research objects. Bacteria were isolated and identified according to the National Clinical Laboratory Operating Procedures, and drug sensitivity tests were carried out by K-B paper method. Hospital infection was collected and counted, and the distribution and drug resistance of pathogenic bacteria in infected patients were retrospectively analyzed. Results: A total of 172 strains of pathogenic bacteria were isolated from blood samples of 160 IE patients, of which 116 strains (67.44%) were Gram positive, mainly Streptococcus viridis, Staphylococcus aureus, and Staphylococcus epidermidis. 52 strains of Gram negative bacteria (30.23%), mainly Klebsiella pneumoniae, Stenotrophomonas maltophilia, and 4 strains of fungi. The highest resistance rate of Streptococcus viridis to chloramphenicol was 90.91%, and that of Staphylococcus aureus to penicillin was 100.00%. There was no resistance to vancomy-cin and linezolid. Klebsiella pneumoniae has the highest resistance rate to ampicillin at 78.23%, while Stenotrophomonas maltophilia has no resistance to clarithromycin or levofloxacin. The bacte-ria have a high resistance rate to ceftriaxone at 86.67%, and are relatively sensitive to gentamicin and ciprofloxacin, with resistance rates of only 6.67% and 13.33%. Conclusion: The pathogen of in-fective endocarditis infection is mainly Gram positive cocci, and the resistance rate to commonly used antibiotics is high. It is of great significance to select antibiotics reasonably according to the distribution and resistance of infective endocarditis pathogens to improve the survival rate of pa-tients.