188例感染性心内膜炎血培养阳性的病原菌分布及药敏分析Pathogen distribution of 188 cases for positive infective endocarditis blood cultures and the drug sensitivity analysis
曾卫强,曲云婷
ZENG Wei-qiang,QU Yun-ting(Pharmaceutical Department of Guangdong General Hospital
摘要(Abstract)：
目的考查本地区近五年来感染性心内膜炎(infective endocarditis,IE)的致病菌分布特点及药敏情况,为临床选择抗菌药物提供参考。方法通过医院电子病历系统筛选我院自2007年1月至2011年12月确诊为IE并经血培养阳性的病例,对其致病菌及药敏结果进行回顾性分析。结果革兰氏阳性菌占IE致病菌的82.4%,其中链球菌40.4%、葡萄球菌24.4%、肠球菌10.6%;革兰氏阴性菌占10.1%,主要是肺炎克雷伯菌3.19%、大肠埃希菌2.12%和铜绿假单胞菌2.12%;真菌占7.4%,主要是念珠菌感染3.19%;药敏结果:链球菌对青霉素敏感率为96.1%,对红霉素和四环素耐药率分别38.2%和45.7%;金黄色葡萄球菌对青霉素耐药率为93.1%,耐甲氧西林金黄色葡萄球菌(methicillin resistant staphylococcusanrens,MRSA)20.7%;均无发现对万古霉素、替考拉宁和利奈唑胺耐药菌株;大肠埃希菌和铜绿假单胞菌对三代头孢耐药率分别为50%和100%。结论链球菌依然是感染IE最常见的致病菌,其次是葡萄球菌和肠球菌;青霉素仍然是链球菌感染IE的首选药物,而金黄色葡萄球菌感染则应避免使用青霉素,但对氧氟沙星、利福平、氨基苷类仍保持有较高的敏感率。链球菌对红霉素和四环素、大肠埃希菌和铜绿假单胞菌对三代头孢的耐药情况应引起重视。
Objective To get clinical references for selection of antibiotics by examining the character of pathogen distribution and drug resistances of infective endocarditis(IE) in this region nearly five years.Methods The pathogens and drug susceptibility of IE and blood culture positive cases in the electronic medical records of our hospital were analyzed retrospectively from January 2007 to December 2011.Results 82.4% of IE pathogens were Gram-positive bacteria,of which were Streptococcus(40.4%),Staphylococcus aureus(24.4%) and Enterococci(10.6%);10.1% of IE pathogens were Gram-negative bacteria,of which were Klebsiella pneumonia(3.19%),Escherichia coli(2.12%) and Pseudomonas aeruginosa(2.12%);7.4% of IE pathogens were fungi,of which were mainly candida(3.19%).Susceptibility results:Streptococci were 96.1% sensitive to penicillin and their resistance rates to erythromycin and tetracycline were 38.2% and 45.7%,respectively.Staphylococcus aureus resistant to penicillin was 93.1% and of which 20.7% was MRSA.There were no amine resistant strains to vancomycin,teicoplanin and linezolid.Resistance rates of Escherichia coli and Pseudomonas aeruginosa to third generation cephalosporin were 50% and 100%,respectively.Conclusions Streptococcus is still the most common pathogen of IE,followed by Staphylococci and Enterococci.Penicillin is the first choice of drug for Streptococcal infection of IE.Infection of Staphylococcus aureus should avoid the use of penicillin because of the high sensitive rate to ofloxacin,rifampin,aminoglycosides.Attention should be paid to resistance of Streptococcus to erythromycin and tetracycline,Escherichia coli and Pseudomonas to third generation cephalosporin.
关键词(KeyWords)：
感染性心内膜炎;致病菌;药敏分析
infective endocarditis;pathogen;susceptibility analysis
基金项目(Foundation):
作者(Author):
曾卫强,曲云婷
ZENG Wei-qiang,QU Yun-ting(Pharmaceutical Department of Guangdong General Hospital
DOI: 10.14066/j.cnki.cn21-1349/r.2012.12.012
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