1例感染性心内膜炎患者的抗菌药物治疗

1例18岁女性患者,因发热50余天入院。患者自幼发现动脉导管未闭,未行手术治疗。入院前50余天出现发热,就诊于多家医院,诊为"感染性心内膜炎",多次血培养中3次提示耐万古霉素金黄色葡萄球菌,1次为万古霉素敏感金黄色葡萄球菌。患者先后接受头孢曲松、青霉素、去甲万古霉素等多种抗菌药物治疗,效果不佳。就诊我院后,心脏超声发现肺动脉外侧壁导管开口附近赘生物,进一步明确心内膜炎诊断,给予大剂量头孢唑啉治疗,感染症状逐步消退,后接受手术治疗,纠正先心病和清除赘生物,术后康复良好。抗感染治疗持续至术后6周停药,随访未发现感染复发症状。

Antimicrobial drug therapy on a patient with infective endocarditis

One 18-year-old female patient was admitted for 50-day fever. She had patent ductus arteriosus since young but hadn＇t received surgical therapy. About fifty days before admission, she developed fever and visited several hospitals, where she was diagnosed as infective endocarditis. Several sets of blood culture were collected, three sets indicated vancomycin-resistant Staphylococcus aureus, and one set indicated vancomycin-susceptible S. aureus. Ceftriaxone, penicillin G and norvacomycin were administered subsequently but therapeutic effect was poor. In our hospital, echocardiogram indicated that there was a vegetation adhering at vessel wall of pulmonary artery and the vegetation was close to ductus arteriosus. After being diagnosed as infective endocarditis, the patient was administered with high dosage of cefazolin and then infectious symptoms abated gradually. Three weeks later, surgical operation was applied to correct patent ductus arteriosus and remove vegetation. The patient recovered well and had got antimicrobial drug therapy for six weeks after operation. Following up the patient, we didn＇t find any symptoms of relapse.