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P0.05)。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。

Pathogenic bacteria distribution and death factors in IE patients

Abstract: Objective To investigate the pathogenic bacteria distribution, drug resistance and death factors in patients with infectious endocarditis (IE). Methods The clinical data of 80 patients with IE admitted to our hospital from November 2014 to March 2018 were retrospectively analyzed. According to the final outcomes, the patients were divided into survival group (75 cases) and death group (5 cases). Blood samples of the patients were collected for bacterial culture, identification and drug sensitivity test, and the death factors were statistically analyzed. Results 96 pathogenic bacteria were detected in 80 IE patients, among which 63 (65.63%) were Gram-positive bacteria, 27 (28.13%) were Gram-negative bacteria, and 6 (6.25%) were fungi. The susceptibility test showed that the resistance rates of Streptococci and Staphylococcus aureus to Penicillin were 90.32% and 93.33% respectively, and those to Erythromycin were 70.97% and 73.33% respectively. Univariate analysis showed that hepatomegaly, hemoglobin <90 g/L and use of antibiotics were associated with mortality in IE patients (all P<0.05). Conclusion Gram positive bacteria were the main pathogenic bacteria in IE patients, and the predominant bacteria were highly resistant to penicillin. Control and treatment of hepatomegaly, hemoglobin and antibiotic-related factors should be strengthened to reduce the mortality of IE patients.