不同病原微生物所致的成人感染性心内膜炎的抗生素治疗

随着心脏介入治疗及心脏外科手术 (如球囊介入扩张术、人工瓣膜置换等 )的进一步开展 ,近几年感染性心内膜炎的患病率有增加的趋势。由于致病微生物耐药菌株的不断增加 ,给临床用药选择增加了困难 ,下面就感染性心内膜炎常见不同的致病微生物 :草绿色链球菌、牛链球菌、肠球菌、葡萄球菌以及ＨＡＣＥＫ类微生物 (副流感嗜血杆菌、嗜沫嗜血杆菌、伴放线放线杆菌、人心杆菌、腐蚀埃肯和金氏村菌 ) ;临床治疗抗生素的选择阐述如下。1　草绿色链球菌和牛链球菌1.1　对青霉素高度敏感的草绿色链球菌或牛链球菌　　此类致病菌所致的感染性心内膜炎…     

草绿色链球菌感染性心内膜炎的病原学特征及临床特点分析

目的 探讨草绿色链球菌引起感染性心内膜炎（IE）的病原学特征和临床特点。方法 选取2016年6月至2021年12月中国医科大学附属第一医院收治的57例血培养阳性IE患者的临床资料。分析其病原菌构成及草绿色链球菌的耐药情况；将患者分为草绿色链球菌组和非草绿色链球菌组，对2组临床特点进行对比。结果 血培养分离病原菌，草绿色链球菌32株，占56.1%，其中戈登链球菌株数最多（11株）。草绿色链球菌耐药性分析结果显示，草绿色链球菌对红霉素和阿奇霉素的耐药性最高，分别为81.3%和78.1%；未见青霉素G、万古霉素、利奈唑胺耐药菌株，青霉素G中介率达28.1%。临床特点分析结果显示，2组先天性心脏病（非主动脉二叶畸形先心病）、入院前病程、二尖瓣赘生物以及心功能不全结果有统计学差异（P <0.05）。结论 草绿色链球菌是IE的最常见致病菌；青霉素仍是经验治疗草绿色链球菌IE的首选药物；病程长、生长二尖瓣赘生物和未发生心功能不全的临床特点对IE患者发生草绿色链球菌感染的病原体评估具有一定的提示作用。     

感染性心内膜炎患者血培养病原菌及其耐药性分析

目的:分析感染性心内膜炎患者血培养病原菌及其耐药性,为临床提供参考。方法:通过对52例2003年9月-2013年9月本院收治的感染性心内膜炎患者进行血培养实验和病原菌耐药性实验,分析感染性心内膜炎患者血培养病原菌及其耐药性。结果:52例患者共筛选出32株病原菌,感染率为61.54%,其中革兰阳性菌株28株,占87.50%,主要为金黄色葡萄球菌、草绿色链球菌、粪肠球菌、牛链球菌、口腔链球菌和表皮葡萄球菌,革兰阳性菌对环丙沙星和庆大霉素耐药性较强,对万古霉素耐药性较差;革兰阴性菌4株,占12.50%,主要为铜绿假单胞、产气肠杆菌和大肠埃希菌,革兰阴性菌对庆大霉素耐药性较强,对头孢哌酮和环丙沙星耐药性较差。结论:金黄色葡萄球菌和草绿色链球菌是感染性心内膜炎的主要致病菌,而这两株菌对万古霉素的耐药性均较差,所以临床上可以用万古霉素作为预防和治疗感染性心内膜炎的主要抗生素,这对临床治疗感染性心内膜炎有重要的指导意义。     

扁桃体脓肿分离出甲型链球菌多形性(G型)一例

甲型溶血性链球菌为人类呼吸道及肠道的正常寄居菌,致病力较低.但在一定条件下,可引起亚急性细菌性心内膜炎,泌尿系感染,在扁桃体、鼻咽部或齿龈中可引起局灶性感染.本文报告一例扁桃体脓肿患者,因用药后培养出多形性细菌,经返祖试验证明为甲型溶血性链球菌.     

前列腺液中草绿色链球菌的菌群分布及耐药性

草绿色链球菌是人体正常菌群的一部分,多数情况下不引起任何症状和疾病,但在机体抵抗力下降情况下,可以引起生殖道、心内膜炎及手术后的软组织感染等[1-3].     

亚急性感染性心内膜炎患者的临床护理

<正>亚急性感染性心内膜炎以草绿色链球菌最多见,其次为D族链球菌(如肠球菌)和表皮葡萄球菌。其他如革兰阴性杆菌、厌氧菌、嗜乳酸杆菌属和类白喉杆菌等,也是感染性心内膜炎的常见致病菌。少数病例由真菌、立克次体、衣原体、病毒(尤其是柯萨奇B病毒)、螺旋体等引起。50%的患者可找到诱发     

间质性肺炎合并感染性心内膜炎的临床报告

目的 探讨间质性肺炎合并感染性心内膜炎的临床效果.方法 药物治疗.结果 后改用斯沃7天,患者体温正常,咳嗽、咳痰、胸闷、气急好转出院.结论 斯沃的组织和体液穿透率较高,尤其在上皮细胞中,其穿透率高达200%,斯沃对大多数临床致病的G+菌都有效,对金葡菌、凝固酶阴性葡萄球菌、肠球菌、肺炎链球菌、B-溶血性链球菌和草绿色链球菌等均具有很高的抗菌活性,对感染性心内膜炎有效.     

咽峡炎链球菌致感染性心内膜炎1例报告并文献复习

咽峡炎链球菌(Streptococcus anginosus)属于米勒链球菌群(Streptococcus milleri group),这个菌群包括咽峡炎链球菌、星座链球菌和中间链球菌3个种[1].咽峡炎链球菌为口腔及鼻咽部的正常菌群,然而咽峡炎链球菌可引起人类各种感染,如蜂窝组织炎、骨髓炎、内心膜炎等.我们于2005年5月,从1例心内膜炎患者的血液中4次分离出咽峡炎链球菌,鉴于国内有关咽峡链球菌引起人类感染的报道尚少,为引起临床及实验室的注意,现报告如下.     

感染性心内膜炎致肾脏损害临床观察

目的：分析感染性心内膜炎致肾脏损害的临床诊断、治疗及预后情况,旨在提高对该类疾病的认识。方法：回顾性分析我院自1998年1月-2008年8月收治的75例感染性心内膜炎病人的临床特点、治疗方法及预后情况。其中4例病人有肾活检组织病理资料。结果：草绿色链球菌为感染性心内膜炎的主要致病菌,其次为金黄色葡萄球菌;感染性心内膜炎引起肾脏损害包括无症状的血尿和（或）蛋白尿（86.4%）,急性肾炎综合征（4.8%）,肾病综合征（1.7%）,急进性肾炎（3.4%）,肾栓塞（3.4%）;4例患者给予激素联合免疫抑制剂治疗。8例急性肾功能衰竭患者,3例肾功能完全恢复。感染性心内膜炎伴肾脏损害组与无肾脏损害组在心脏结构病变与致病菌方面差异无统计学意义（P〉0.5）。结论：感染性心内膜炎引起肾脏损害很常见,多数为无症状的血尿和（或）蛋白尿;肾栓塞,肾病综合征,急性肾炎综合征,急进性肾炎综合征也可以出现;心脏结构改变不能增加感染性心内膜炎肾损害的发生;草绿色链球菌仍然为感染性心内膜炎的主要致病菌,其次为金黄色葡萄球菌。对于感染性心内膜炎所致的重度增生性肾炎,在感染得到有效控制的前提下,可适当给予糖皮质激素（包括冲击）及免疫抑制治疗。     

感染性心内膜炎114例临床分析

本文对114例感染性心内膜炎(IE)进行临床分析,提示40岁以上的患者增多,发生于无器质心脏病者有增高趋势.血培养阴性率48.25%,仅有8例致病菌为草绿色链球菌,而金葡菌和溶血性链球菌及革兰氏阴性杆菌则有增加.临床表现常不典型,误诊率为15.29%.因此,必须对 IE予以警惕.对 IE 患者需尽早给予有效足量抗菌素治疗.     

Aneurysm of the mitral valve complicating Streptococcus milleri endocarditis

A case of Streptococcus milleri endocarditis which caused an aneurysm of the anterior leaflet of the mitral valve is reported. There is only one previous report of a mitral valve aneurysm secondary to infective endocarditis demonstrated by angiography. Streptococcus milleri normally causes endocarditis in an older age group than the patient we describe. Some salient features of this increasingly recognized human pathogen are emphasized.     

The use of a new glycopeptide antibiotic, teicoplanin, in the treatment of bacterial endocarditis

Teicoplanin, a new glycopeptide antibiotic, has been used to treat twelve patients with bacterial endocarditis due to Gram-positive organisms. Teicoplanin has activity against Gram-positive bacteria similar to vancomycin but therapeutic levels are maintained by a single daily dose, given as an intravenous bolus. Of six patients with native valve infections, two cases, due to viridans streptococci, were successfully treated with teicoplanin alone and two others, caused by Streptococcus faecalis, were cured by combinations including teicoplanin. One of these patients sustained high tone hearing loss during treatment. The remaining two patients were drug addicts with endocarditis due to Staphylococcus aureus which recurred despite repeated multiple therapy. Of six prosthetic valve infections, antibiotic combinations including teicoplanin cured three cases, caused by streptococci. Infection persisted or treatment was curtailed in three cases of Staphylococcus epidermidis endocarditis. In this small open study, teicoplanin appeared as effective as vancomycin in the treatment of endocarditis but had the considerable advantage of ease of administration.     

Bacteremia caused by viridans streptococci in 71 children.

A review of the hospital records of 71 patients from whose blood viridans streptococci were isolated showed that in 13 cases the patient's illness was definitely related to the bacteremia: 4 patients had endocarditis, 3 had pneumonia, 2 had peritonitis and 1 each had meningitis, a scalp wound infection, sinusitis and otitis media. The bacteremia may have contributed to the two deaths among these 13 patients. In 45 cases the viridans streptococci may have contributed to the patient's illness: 15 patients had an infection of the lower respiratory tract and 7 an infection of the upper respiratory tract, 8 were neonates with suspected septicemia, 3 had soft tissue infections, 3 had leukemia and sepsis, and 9 had miscellaneous infections; the bacteremia was unrelated to the two deaths in this group. In another 13 cases the viridans streptococci could not be related to the patient's illness. The species most frequently isolated were Streptococcus mitis, S. sanguis II and S. MG-intermedius. The outcome of the bacteremia was generally good, even among the 11 patients not treated with antibiotics. When viridans streptococci are cultured from a single blood sample, further samples of blood and, if feasible, specimens from the associated focus of infection should be obtained for culture; further blood cultures are especially important in cases of suspected endocarditis.     

Pyogenic infection and rheumatoid arthritis

Ten episodes of severe pyogenic infection occurring in nine patients with rheumatoid arthritis are reported. There was a wide range of presenting features including pyoarthrosis in 7 episodes. Three cases presented with meningitis, bacterial endocarditis and probable multiple abscesses respectively. Infection was caused by Staphylococcus aureus in 7 episodes and by Staphylococcus epidermidis, Streptococcus pneumoniae and beta-haemolytic Streptococcus in each of one episode. Three infective episodes were fatal. Pyogenic, especially staphylococcal, infection should be considered in patients with rheumatoid arthritis with unexplained illness with or without sudden deterioration in joint symptoms. It is important to recognize and treat infection rapidly.     

Staphylococcal septicaemia, endocarditis, and osteomyelitis in dialysis and renal transplant patients.

Septicaemia is a common and potentially lethal hazard of haemodialysis and renal transplantation; it is usually caused by Staphylococcus pyogenes. In 6 patients with S. pyogenes septicaemia, fatal endocarditis and spinal osteomyelitis have each occurred once, and 3 patients have had recurrent episodes of septicaemia. The management of septicaemia in these patients must include a search for metastatic infection, and prolonged therapy with 2 antistaphylococcal agents is necessary to ensure eradication of infection. Access site infection in dialysis patients must be treated vigorously, and recognized as potentially hazardous by patients. The risk of sepsis in dialysis and transplant patients cannot be excluded, but devastating consequences may be avoided by simple measures.     

Streptococcus bovis endocarditis as a presenting manifestation of idiopathic ulcerative colitis.

Streptococcus bovis bacteraemia and endocarditis have been associated with several gastrointestinal diseases, mainly malignant or potentially malignant tumours, and less commonly non-malignant gastrointestinal disorders. We describe a 73 year old man in whom Streptococcus bovis endocarditis developed, and was the presenting manifestation of undiagnosed quiescent ulcerative colitis. Such an association has not been described previously.     

Colon cancer presenting as Streptococcus gallolyticus infective endocarditis

A 58-year-old Chinese man presented with a three-week history of fever. He had a background history of rheumatic heart disease, hypertension, and thalassaemia. He was found to have infective endocarditis of the aortic valve due to Streptococcus gallolyticus. During the hospital stay, he developed a few episodes of haematochaezia and was subsequently found to have colonic carcinomain- situ. He completed appropriate antibiotic treatment for his infective endocarditis and underwent a left hemicolectomy with primary anastomosis. The association between Streptococcus gallolyticus infective endocarditis and colonic neoplasm is well documented. This case report stresses the importance of performing routine colonoscopy to look for colonic neoplastic change in patients diagnosed to have Streptococcus gallolyticus infective endocarditis. The early diagnosis of the colonic neoplasm has enabled our patient to have a curative surgery without compromising his quality of life.     

The heterogeneity of Streptococcus viridans: therapeutic considerations in infective endocarditis

A 24-year-old woman with Marfan's syndrome and mitral regurgitation had clinical features suggestive of infective endocarditis. The causative organism was Streptococcus viridans. Initial therapy with penicillin G, in a dose that should have been bactericidal and hence curative according to the results of the initial quantitative antimicrobial studies, became inadequate. The strain of S. viridans displayed considerable variation in both growth properties and antimicrobial sensitivity during the course of therapy. In addition, a different strain of S. viridans was cultured 1 month after treatment had begun. It is therefore important to repeat cultures and antimicrobial sensitivity testing during treatment of infective endocarditis.     

变形链球菌葡糖基转移酶基因在戈登链球菌中的表达

目的:通过探讨变形链球菌葡糖基转移酶基因在戈登链球菌中的表达,了解葡糖基转移酶对戈登链球菌生物学特性的影响。方法:携带的大肠杆菌链球菌穿梭质粒pZB1转化戈登链球菌,利用蛋白质免疫印迹技术确认葡糖基转移酶基因在转化株中表达,通过检测转化株菌落形态以及蔗糖依赖性粘附了解葡糖基转移酶对戈登链球菌生化特性的影响。结果:戈登链球菌的菌落形态由转化前的光滑型变为转化后的半粗糙型,转化菌株的蔗糖依赖性粘附较转化前明显降低。结论:变形链球菌的葡糖基转移酶在戈登链球菌中的表达增加了细菌之间的聚集,葡糖基转移酶与戈登链球菌的粘附因子相互作用,降低了细菌的蔗糖依赖性粘附。     

Bacterial Endocarditis with Candida Albicans Superinfection

Clinical and pathological features of two fatal cases of bacterial endocarditis with Candida albicans superinfection are described. One patient presented with combined Streptococcus viridans and Candida endocarditis of the aortic valve. The second patient, an addict to paregoric injected intravenously, developed Staphylococcus aureus of the tricuspid valve with eventual Candida endocarditis. The responsible organisms were identified from blood cultures during the hospital course, and by culture or tissue section of postmortem material. Candida endocarditis has emerged as a disease entity in the past 20 years. The incidence is increasing and patients with bacterial endocarditis are among those at risk. Antibiotic therapy appeared to facilitate the development of Candida endocarditis in these two cases.