感染性心内膜炎患者前驱感染症状、病原菌检测及抗菌药物治疗情况调查

目的 回顾性分析感染性心内膜炎患者的前驱感染症状、病原菌检测及抗菌药物治疗情况，加强对感染性心内膜炎诊疗的认识，为提高感染性心内膜炎诊疗水平提供理论依据。 方法 选择2013年1月—2017年12月期间杭州市西溪医院收治的173例感染性心内膜炎患者为研究对象，回顾性分析感染性心内膜炎患者的临床特点(一般资料、前驱感染情况、病原菌检测结果、基础疾病及易感因素)及抗菌药物治疗情况。 结果 173例感染性心内膜炎患者中，男性发病率高于女性，平均发病年龄为(9.13±3.19)岁，平均住院时间为(8.41±1.23)d。其中75例(43.35%)具有明显的前驱感染症状，以肺部感染为主(33.53%)，且部分病例存在合并两处感染情况。共113例(65.32%)血培养阳性反应，共培养出118株病原菌，链球菌占比最高有60株(50.85%)，葡萄球菌属共37株(31.36%)，革兰氏阴性杆菌4株(3.39%)，真菌8株(占比6.78%)。常用抗菌药物主要有青霉素类抗菌药物、万古霉素类抗菌药物和头孢类抗菌药物，青霉素类抗菌药物使用率逐年下降(从82.71%下降到54.21%)，万古霉素类抗菌药物和头孢类抗菌药物使用率逐年上升，分别从53.66%和49.54%上升到89.15%和74.63%。 结论 感染性心内膜炎的前期感染症状以肺部感染为主，以链球菌及葡萄球菌感染为主，还包括革兰氏阴性杆菌、真菌等。青霉素类抗菌药物使用率逐年下降，万古霉素类抗菌药物和头孢类抗菌药物使用率逐年上升。 

Investigation and analysis of the clinical characteristics of infective endocarditis and the treatment of antiseptic drugs

Objective To strengthen the understanding of the treatment of infective endocarditis, andprovide a theoretical basis for improving the level of diagnosis and treatment of infective endocarditis by retrospective analysis of pre-infection symptoms, pathogen detection and antibiotic treatment in patients with infective endocarditis. Methods The 173 cases of infective endocarditis patients admitted to our hospital from January 2013 to December 2017, according to the Diagnostic Criteria of Infectious Endocarditis of the Chinese Medical Association,were reviewed.Sexual analysis of clinical features of patients with infective endocarditis(general information, pre-infection, pathogen detection results, underlying diseases and susceptibility factors) and antibiotic treatment. Results Among 173 patients with infective endocarditis, the incidence rate of males was higher than that of females. The average age of onset was (9.13±3.19) years old, and the average length of hospital stay was (8.41±1.23) days. Among them, 75 cases (43.35%) had obvious symptoms of prodromal infection, mainly pulmonary infection (33.53%), and some cases had two infections. A total of 113 cases(65.32%) were positive for blood culture. A total of 118 pathogens were cultured. The highest proportion of streptococci was 60 (50.85%), 37 strains of Staphylococcus (31.36%) and 4 strains of Gram-bacillus (3.39%), 8 strains of fungi (6.78%). Common antibiotics mainly include penicillin antibiotics, vancomycin antibiotics and cephalosporin antibiotics. The use rate of penicillin antibiotics has decreased year by year (from 82.71% to 54.21%), and the use rate of vancomycin antibiotics and cephalosporin antibiotics has increased year by year, rising from 53.66% and 49.54% to 89.15% and 74.63%, respectively. Conclusion The pre-infection symptoms of infective endocarditis are mainly pulmonary infections, streptococcus and staphylococcal infections, including Gram-bacillus and fungi. The use rate of penicillin antibiotics has been decreasing year by year, and the use rate of vancomycin antibiotics and cephalosporin antibiotics has increased year by year.