感染性心内膜炎的外科治疗

本文报告经手术治疗的10例原发性感染性心内膜炎病人,对该病的手术指征、术前准备、术中及术后处理及常见并发症等进行讨论。     

感染性心内膜炎并发脑卒中4例报告

由于抗生素的广泛应用,心导管及心脏手术的开展引起的感染性心内膜炎病原体发生了改变,临床不典型病例增加,病情迁延,并发症增多．病死率高。现将我院2006-2007年收冶的4例感染性心内膜炎并发脑卒中报告如下。     

里昂葡萄球菌致感染性心内膜炎的临床分析

目的:探讨里昂葡萄球菌对感染性心内膜炎的临床特点及其菌株鉴定的要点.方法:对21例感染性心内膜炎患者的临床特征及血液中分离的菌株鉴定与药敏试验作一回顾性分析.结果:患者不规则发热,均从血液中分离出里昂葡萄球菌.菌株鉴定的特征是玻片法凝固酶试验阳性,试管法凝固酶试验阴性;鸟氨酸脱羧酶阳性;对青霉素类药物敏感,不产生β-内酰胺酶.结论:腹股沟、会阴及腋窝等处的手术切口是里昂葡萄球菌感染的适宜部位,由该菌引起的心内膜炎并发症与金黄色葡萄球菌有类似的致病力,在菌株的鉴定与鉴别上应引起重视.     

感染性心内膜炎患者致病菌分布及死亡因素分析

目的 探讨感染性心内膜炎（IE）患者致病菌分布、致病菌耐药性及患者死亡因素。方法 回顾性分析我院2014年11月至2018年3月收治的80例感染性心内膜炎患者的临床资料。根据是否发生死亡将患者分成存活组（75例）与病死组（5例）。采集两组患者血液标本进行细菌培养、鉴定及药敏试验,并对患者死亡因素进行统计。结果 80例IE患者共检测出96株病原菌,其中革兰阳性菌63株,占65.63%;革兰阴性菌27株,占28.13%;真菌6株,占6.25%。药敏试验显示链球菌属及金黄色葡萄球菌对青霉素耐药率最高,分别为90.32%和93.33%;其次为红霉素,分别为70.97%和73.33%。单因素分析结果显示,肝脏肿大、血红蛋白（<90 g/L）及抗生素的使用与IE患者的死亡有关（均P<0.05）。结论 IE患者病原菌以革兰阳性菌为主,其主要菌属对青霉素耐药率最高,要加强对肝脏肿大、血红蛋白及抗生素相关因素的防治,降低IE患者的病死率。     

少动鞘氨醇单胞菌致感染性心内膜炎1例

少动鞘氨醇单胞菌(Sphingomonas paucimobilis) 是一种少见的条件致病菌,可引起手术后感染、创伤后腿部溃疡、菌血症、脑膜炎、慢性蜂窝织炎、手术后眼内炎等,未查见累及心瓣膜的报道.本文报道1例由少动鞘氨醇单胞菌所致感染性心内膜炎的病例.该患者为中年男性,因\"反复发热2月余\"入院.以发热伴左上腹痛为首...     

马方综合征并发感染性心内膜炎的外科治疗体会

目的：探讨马方综合征并发感染性心内膜炎的外科治疗的体会。方法：回顾性分析2009年7月至2012年12月我院30例马方综合征并发感染性心内膜炎患者,男19例,女11例,年龄23.58（41．6±15．2）岁,所有患者均进行了抗生素治疗和心瓣膜置换或成形术,其中对患者进行经典Bent,all手术12例,纽扣法Bentall手术18例,比较分析手术治疗马方综合征并发感染性心内膜炎疗效。结果：手术时间276．742（405．0±125．0）min,体外循环时间115—319（159．0±43．0）rain,机械通气辅助时间1～12（2．4±2．0）d．住院时间10．60（28．5±11．0）d,术后出现并发症有7例,经二期手术治愈有5例,2例抢救无效死亡,并发症发生率为23.3％,死亡率为6．7％。结论：对于马方综合征并发感染性心内膜炎患者,正确把握手术的时机和抗感染药物治疗剂量,积极采取外科手术治疗是最佳的治疗方法。     

感染性心内膜炎与肠道菌群的相关性研究

目的 探讨感染性心内膜炎与肠道乳杆菌、双歧杆菌和大肠埃希菌的临床相关性。方法 选择2008年4月至2016年4月湖州市第一人民医院心内科病房收治的单纯感染性心内膜炎患者67例为观察组,选择同期来院体检结果正常者65例为对照组。分别收集观察组患者治疗前1天、治疗第3天和治疗1周后3个不同时间节点的粪便标本,同时收集对照组的粪便标本,通过FISH实验检测粪便中双歧杆菌和乳杆菌的含量差异,同时通过16SrRNA/DNA荧光定量PCR技术进一步明确观察组患者3个时期肠道双歧杆菌、大肠埃希菌和乳杆菌与对照组的数量差异。结果 观察组患者治疗前1天双歧杆菌值为6.2%±0.56%,治疗第3天为4.3%±0.34%,治疗1周后为8.7%±0.56%,对照组双歧杆菌值为9.4%±0.98%。观察组患者治疗前1天乳杆菌值为5.4%±0.86%,治疗第3天为4.9%±0.24%,治疗1周后为6.1%±0.72%,对照组乳杆菌值为8.3%±0.51%。治疗前1天与治疗1周后,观察组患者双歧杆菌和乳杆菌值与对照组相比,差异均有统计学意义（P<0.05）。16SrRNA/DNA荧光定量PCR检测表明,观察组患者在3个治疗时期中肠道乳杆菌、双歧杆菌和大肠埃希菌数量的对数值与对照组比较差异均有统计学意义（P<0.05）。其中观察组患者双歧杆菌和乳杆菌数量在治疗第3天较低,1周后有所回升;大肠埃希菌数量在治疗第3天亦较低, 但1周后没有明显回升。结论 感染性心内膜炎患者肠道菌群数量与健康人相比有所下降,肠道乳杆菌、大肠埃希菌和双歧杆菌失调可能影响其发病和转归。     

巴尔通体感染性心内膜炎的研究进展

感染性心内膜炎一直是威胁人类健康的重要疾病之一。近年来人类正面临着此病发病率持续上升的局面,其诊断、治疗和预防依然是目前需要解决的重要临床和公共卫生问题。本文介绍了感染性心内膜炎疾病的最新研究进展,分析了国内外报道的538份巴尔通体感染性心内膜炎的病例,重点阐述了巴尔通体和相关心内膜炎的流行病学、实验室诊断、治疗以及发病的危险因素和预防控制措施。预测这些研究将对人类理解和控制巴尔通体感染性心内膜炎具有重要的指导意义。     

141例小儿感染性腹泻临床特征及流行病学分析

目的:探讨儿童感染性腹泻(Infectious diarrhea,ID)的临床特征及病原菌学流行病特点,为临床防治提供理论依据。方法:回顾性分析我院2010年2月至2014年2月收治并确诊的141例感染性腹泻患儿的粪便培养结果,观察并总结患者体内大肠埃希菌、痢疾杆菌、肺炎克雷伯菌病毒等常见致病细菌的分布情况。结果:儿童感染性腹泻四季均可发病,夏季发病率最高,春季最低;年龄为1月~3岁的患儿感染性腹泻细菌及病毒感染比例显著高于其他两组(P0.05);141例患儿中,细菌阳性23例(16.3%),病毒培养阳性94例(66.7%)。各种病毒感染与患儿性别无关(P0.05)。结论:小儿感染性腹泻四季均较常见,病毒感染比例高于细菌感染比例,应根据病原菌分布情况积极采取预防与控制措施。     

肠球菌感染性心内膜炎中粪肠球菌毒力因子的作用

肠球菌是革兰阳性球菌。1984年,肠球菌作为一个新的菌属从链球菌属中独立出来,即肠球菌属(enterococcus)。肠球菌营养要求较高,在含有血清的培养基上生长较好。接种血平板35℃孵育18 h后,可形成灰白色、不透明、表面光滑、直径为0.5-1 mm大小的圆形菌落,在血琼脂平板培养基上主     

静脉毒瘾者金黄色葡萄球菌性感染性右心内膜炎(附2例报告及文献复习)

本文在国内首次报道２例静脉毒瘾者金黄色葡萄球菌性感染性右心内膜炎（ＳＩＲＥＤ）,其临床特点：①常合并有肝炎病毒感染;②确诊有赖于心脏超声检查发现三尖瓣赘生物、细菌的毒血症状及血培养的结果;③治疗应根据药敏结果选择２至３种敏感的抗生素联用,其剂量应比常规量大２至３倍,疗程６至８周或更长;④有效治疗后,该病预后良好     

The role of endothelial cell biology in endocarditis

The treatment of endocarditis remains a challenge for physicians, even in times of modern antibiotic treatment. Depending on its cause, endocarditis can either be of infectious or non-infectious origin. Infective endocarditis is caused by bacterial (or fungal) pathogens, and the clinical course is critically dependent on the virulence factors of the specific microorganisms involved. Therefore, the clinical type of endocarditis can be divided into an acute and more aggressive form and a subacute form (endocarditis lenta). Much of our knowledge regarding the pathogenesis of infective endocarditis is based on studies of the virulence of Staphylococcus aureus, which has become the most frequent cause of infective endocarditis nowadays. However, independently of the underlying cause of endocarditis (infectious or noninfectious), the pathogenesis involves the damage and disturbance of endothelial function and the formation of associated “vegetation”. Surprisingly little is known about the specific role of the endothelium in the pathogenesis of endocarditis. This review will thus give insights into current knowledge of the pathogenesis of endocarditis with a focus on the role of the endothelium.     

老年性肺炎的临床特点及病原学分析

目的调查分析老年肺炎的危险因素、病原学特点及临床特征。方法收集2005年1月至2009年3月呼吸内科住院的72例老年肺炎患者病例,统计并分析其临床特点及细菌培养结果。结果本组资料显示大部分患者有基础疾病及易感因素,临床表现不典型;共检出病原菌108株,其中革兰阴性杆菌63株（58.3%）;混合感染35例,占48.6%,二重感染13例,占18.1%。结论提高对老年肺炎的诊断率,根据其病原学特征合理使用抗生素,并建议对老年肺炎患者采用降阶梯疗法,以提高治愈率。     

Identification of pathogens in culture-negative infective endocarditis cases by metagenomic analysis

Background

Pathogens identification is critical for the proper diagnosis and precise treatment of infective endocarditis (IE). Although blood and valve cultures are the gold standard for IE pathogens detection, many cases are culture-negative, especially in patients who had received long-term antibiotic treatment, and precise diagnosis has therefore become a major challenge in the clinic. Metagenomic sequencing can provide both information on the pathogenic strain and the antibiotic susceptibility profile of patient samples without culturing, offering a powerful method to deal with culture-negative cases.

Methods

To assess the feasibility of a metagenomic approach to detect the causative pathogens in resected valves from IE patients, we employed both next-generation sequencing and Oxford Nanopore Technologies MinION nanopore sequencing for pathogens and antimicrobial resistance detection in seven culture-negative IE patients. Using our in-house developed bioinformatics pipeline, we analyzed the sequencing results generated from both platforms for the direct identification of pathogens from the resected valves of seven clinically culture-negative IE patients according to the modified Duke criteria.

Results

Our results showed both metagenomics methods can be applied for the causative pathogen detection in all IE samples. Moreover, we were able to simultaneously characterize respective antimicrobial resistance features.

Conclusion

Metagenomic methods for IE detection can provide clinicians with valuable information to diagnose and treat IE patients after valve replacement surgery. However, more efforts should be made to optimize protocols for sample processing, sequencing and bioinformatics analysis.

     

Genome-based approaches to develop epitope-driven subunit vaccines against pathogens of infective endocarditis

Infective endocarditis (IE) has emerged as a public health problem due to changes in the etiologic spectrum and due to involvement of resistant bacterial strains with increased virulence. Developing potent vaccine is an important strategy to tackle IE. Complete genome sequences of eight selected pathogens of IE paved the way to design common T-cell driven subunit vaccines. Comparative genomics and subtractive genomic analysis were applied to identify adinosine tri phosphate (ATP)-binding cassette (ABC) transporter ATP-binding protein from Streptococcus mitis (reference organism) as common vaccine target. Reverse vaccinology technique was implemented using computational tools such as ProPred, SYFPEITHI, and Immune epitope database. Twenty-one T-cell epitopes were predicted from ABC transporter ATP-binding protein. Multiple sequence alignment of ABC transporter ATP-binding protein from eight selected IE pathogens was performed to identify six conserved T-cell epitopes. The six selected T-cell epitopes were further evaluated at structure level for HLA-DRB binding through homology modeling and molecular docking analysis using Maestro v9.2. The proposed six T-cell epitopes showed better binding affinity with the selected HLA-DRB alleles. Subsequently, the docking complexes of T-cell epitope and HLA-DRBs were ranked based on XP Gscore. The T-cell epitope (208-LNYITPDVV-216)–HLA-DRB1^?0101 (1T5?W) complex having the best XP Gscore (?13.25?kcal/mol) was assessed for conformational stability and interaction stability through molecular dynamic simulation for 10?ns using Desmond v3.2. The simulation results revealed that the HLA-DRB–epitope complex was stable throughout the simulation time. Thus, the epitope would be ideal candidate for T-cell driven subunit vaccine design against infective endocarditis.     

三角孢小囊菌导致的心内膜炎1例

本文报道1例继发于植入心脏起搏器所致的三角孢小囊菌(Microascus trigonosporus)心内膜炎,此菌分离自患者起搏器电极表面的赘生物.赘生物组织病理切片显示大量有隔真菌丝,间生膨大的厚壁孢子.小囊菌系帚霉菌(Scopulariopsis)的有性阶段,广泛存在于自然界.目前国外已有短帚霉菌(Scopula...