感染性心内膜炎730例病原菌构成及药敏分析

目的 分析感染性心内膜炎（infective endocarditis,IE）患者病原菌构成及药敏结果,为本地区经验性抗感染方案的制订提供依据.方法 对2006年1月至2012年9月在广东省人民医院住院的730例IE患者的血培养结果资料进行回顾性分析.结果 （1）血培养阳性率为28.6％,病原菌构成：革兰阳性球菌157例（75.1％）,革兰阳性杆菌15例（7.2％）,革兰阴性杆菌18例（8.6％）,假丝酵母菌18例（8.6％）;最常见细菌为链球菌（40.7％）、葡萄球菌（23.4％）、肠球菌（10.5％）.（2）药敏：在革兰阳性球菌中,链球菌、肠球菌对氨苄西林和青霉素的敏感性比较,差异无统计学意义（94.9％ vs.90.6％,P=0.25; 77.8％ vs.84.2％,P=0.53）；但葡萄球菌对氨苄西林的敏感性显著高于青霉素,差异有统计学意义（58.8％ vs.7.0％,P＜0.001）.革兰阳性菌对糖肽类药物普遍敏感,氨基糖甙类对葡萄球菌及革兰阴性杆菌都有较高的抗菌活性.结论 广东省人民医院IE患者病原菌血培养阳性率低,病原菌以革兰阳性球菌多见；病原菌未明时,宜选择氨苄西林或糖肽类联合氨基糖苷类抗生素作为本区域经验性抗感染方案.

Analysis of pathogens and drug sensitivity in 730 cases with infective endocarditis

Objectives To analyze the distribution and drug sensitivity of pathogens causing infective endocarditis （IE） so as to provide the basis for initial empirical antimicrobial therapy.Methods Blood culture results of 730 cases with IE in Guangdong General Hospital from January 2006 to September 2012 were retrospectively analyzed.Results （1） Positive blood cultures were found in 209 cases （28.6%）,of which,157 cases （75.1%） were gram-positive cocci,15 cases （7.2%） were gram-positive bacteria,18 cases （8.6%） were gram-negative bacilli,18 cases （8.6%） were fungus.Meanwhile,the most common microorganisms were streptococci （40.7%）,staphylococci（23.4%） and enterococci （10.5%）.（2）Among gram-positive cocci,streptococci and enterococci were both highly sensitive to ampicillin and penicillin,and the differences between them were not significant （94.9% vs.90.6%,P=0.25; 77.8% vs.84.2%,P=0.53）; Staphylococci was much more sensitive to ampicillin than to penicillin （58.8% vs.7.0%,P〈0.001）.Grampositive bacteria were highly sensitive to glycopeptides.Aminoglycosides showed high antibacterial activity against staphylococci and gram-negative bacilli.Conclusions Positive rate of blood culture in patients with IE in Guangdong General Hospital is low.Gram-positive cocci is the predominant pathogen of IE.Ampicillin or glycopeptides plus aminoglycosides are recommended for initial empirical treatment for IE.