摘要
目的研究感染性心内膜炎患者的血培养分离株的分布和流行特点,为临床合理用药提供依据。方法收集2014年1月-2017年12月西宁地区190例感染性心内膜炎患者血液标本。采用VTIEK-32全自动微生物鉴定仪进行菌种鉴定。采用抗菌药物最低抑菌浓度法(MIC)进行药敏试验。采用PCR扩增检测草绿色链球菌、酿脓链球菌、金黄色葡萄球菌、粪肠球菌、肺炎克雷伯菌和大肠埃希菌的常见耐药基因。结果 190例感染性心内膜炎患者中有基础心脏病的156例,其中非风湿性瓣膜心脏病87例,风湿性瓣膜心脏病31例,先天性心脏病38例。检出病原菌92株,其中革兰阳性球菌76株,革兰阴性球菌14株,真菌2株;草绿色链球菌37株,酿脓链球菌12株,金黄色葡萄球菌11株。草绿色链球菌对常用抗生素头孢他啶、头孢噻肟、哌拉西林、氨曲南、亚胺培南、美罗培南、四环素、红霉素、螺旋霉素、庆大霉素、妥布霉素、阿米卡星、氧氟沙星、环丙沙星、加替沙星、利福平、万古霉素的耐药率分别为18.92%、21.62%、21.62%、16.22%、0.00%、0.00%、29.73%、32.43%、13.51%、18.92%、13.51%、5.41%、24.32%、18.92%、8.11%、5.41%和0.00%;酿脓链球菌耐药率为25.00%、25.00%、25.00%、16.67%、0.00%、0.00%、41.67、50.00%、25.00%、33.33%、25.00%、16.67%、33.33%、25.00%、16.67%、8.33%和0.00%。未发现万古霉素耐药株,所有菌株对亚胺培南、美罗培南、阿米卡星、加替沙星和利福平耐药程度低。草绿色链球菌耐药基因检出情况为:erm A(1株),ermB(4株),mef A(1株),mef E(3株),tetM(5株);酿脓链球菌为:ermB(2株),mef A(1株),mef E(13株),tetM(3株)。结论感染性心内膜炎患者血清分离出病原菌较广,但草绿色链球菌仍是主要致病菌,其耐药程度并不高。医师可以根据患者血清分离出病原菌的药敏试验,进行合理用药。
Objective To study the distribution and epidemiological characteristics of pathogens isolated from blood cultures from patients with infective endocarditis in order to provide a basis for rational drug use in clinical settings. Methods Blood samples were collected from 190 patients with infective endocarditis in Xining from January 2014 to December 2017. Pathogen strains were identified by the VTIEK-32 Automated Microbiology System. An antimicrobial susceptibility test was performed using the minimum inhibitory concentration(MIC) method. Common drug resistance genes in Streptococcus viride, S. pyogenes, S. aureus, Enterococcus faecalis, Klebsiella pneumoniae, and Escherichia coli were detected via amplification with PCR. Results Of the 190 patients with infective endocarditis, 156(82.11%) had heart disease. Of those, 87(45.26%) had non-rheumatic valvular heart disease, 31(16.32%) had rheumatic valvular heart disease, and 38(20%) had congenital heart disease. Ninety-two strains of pathogens were detected. Of those, 76(82.61%) were strains of Gram-positive cocci, 14 were strains of Gram-negative cocci, and 2 were strains of fungi. The three most prevalent pathogens were 37 strains of S. viride(40.22%), 12 strains of S. pyogenes(13.4%), and 11 strains of S. aureus(11.96%). The resistance of S. viride to commonly used antibiotics was determined. S. viride was resistant to ceftazidime at a rate of 18.92%, to cefotaxime at a rate of 21.62%, to piperacillin at a rate of 21.62%, to aztreonam at a rate of 16.22%, to imipenem at a rate of 0.00%, to meropenem at a rate of 0.00%, to tetracycline at a rate of 29.73%, to erythromycin at a rate of 32.43%, to spiramycin at a rate of 13.51%, to gentamicin at a rate of 18.92%, to tobramycin at a rate of 13.51%, to amikacin at a rate of 5.41%, to ofloxacin at a rate of 24.32%, to ciprofloxacin at a rate of 18.92%, to gatifloxacin at a rate of 8.11%, to rifampicin at a rate of 5.41%, and to vancomycin at a rate of 0.00%. The resistance of S. pyogenes to commonly used antibiotics was determined. S. pyogenes was resistant to ceftazidime at a rate of 25.00%, to cefotaxime at a rate of 25.00%, to piperacillin at a rate of 25.00%, to aztreonam at a rate of 16.67%, to imipenem at a rate of 0.00%, to meropenem at a rate of 0.00%, to tetracycline at a rate of 41.67%, to erythromycin at a rate of 50.00%, to spiramycin at a rate of 25.00%, to gentamicin at a rate of 33.33%, to tobramycin at a rate of 25.00%, to amikacin at a rate of 16.67%, to ofloxacin at a rate of 33.33%, to ciprofloxacin at a rate of 25.00%, to gatifloxacin at a rate of 16.67%, to rifampicin at a rate of 8.33%, and to vancomycin at a rate of 0.00%. No vancomycin-resistant strains were found, and all strains were less resistant to imipenem, meropenem, amikacin, gatifloxacin and rifampicin. Common drug resistance genes were detected. The drug resistance genes of S. viridis that were detected were erm A(1 strain), ermB(4 strains), mef A(1 strain), mef E(3 strains), and tetM(5 strains). The drug resistance genes of S. pyogenes that were detected were ermB(2 strains), mef A(1 strains), mef E(13 strains), and tetM(3 strains). Conclusion A wide range of pathogens was isolated from the serum of patients with infective endocarditis, but the most prevalent was S. viride. S. viride had a low level of drug resistance. Physicians should isolate pathogens from patient serum based on a drug susceptibility test, and they should use drugs rationally.
作者
景增秀
康桂兰
魏秀邦
刘彦武
JING Zeng-xiu;KANG Gui-lan;WEI Xiu-bang;LIU Yan-wu(Vascular Cardiology,The Second Hospital of Xining City,Xining,China 810003;Vascular Cardiology,People's Hospital of the City of Wuzhong)
出处
《中国病原生物学杂志》
CSCD
北大核心
2019年第2期203-207,212,共6页
Journal of Pathogen Biology
关键词
感染性心内膜炎
病原菌
流行特点
Infective endocarditis
pathogens
epidemiological characteristics
作者简介
通讯作者:刘彦武,E-mail:v503519@163.com;景增秀(1978-),女,青海大通人,本科,副主任医师。研究方向:心血管内科疾病诊断及治疗。E-mail:e803201@163.com.
