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
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摘要
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。
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.
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.
引文
[1] 熊祝嘉,岳志刚,李小瑛.20例感染性心内膜炎病原菌及耐药性分析[J].中华全科医学,2013,11(3):467-468.
[2] HARRISON J L,PRENDERGAST B D,HABIB G.The European society of cardiology 2009 guidelines on the prevention,diagnosis,and treatment of infective endocarditis:key messages for clinical practice[J].Pol Arch Med Wewn,2009,119(12):773-776.
[3] 谢红梅,胡必杰,周春妹,等.218例感染性心内膜炎临床和病因学特征及预后分析[J].中华内科杂志,2014,53(5):363-367.
[4] 张岩,孙寒松,胡盛寿,等.感染性心内膜炎104例的临床分析[J].中国胸心血管外科临床杂志,2013,20(5):604-606.
[5] BADDOUR L M,WILSON W R,BAYER A S,et al.Infective endocarditis in adults:diagnosis,antimicrobial therapy,and management of complications:a scientific statement for healthcare professionals from the american heart association[J].Circulation,2015,132(15):1435-1486.
[6] 中华医学会儿科学分会心血管学组.小儿感染性心内膜炎的诊断标准(试行)[J].中华儿科杂志,2001,39(5):310.
[7] CAHILL T J,PRENDERGAST B D.Infective endocarditis[J].Lancet,2016,387(10021):882-893.
[8] 梁峰,胡大一,沈珠军,等.2015年欧洲心脏病学会关于感染性心内膜炎诊断及治疗指南的解读[J].中国医院用药评价与分析,2017,17(2):160-166.
[9] 钱纪江,章瑾,孟德莉,等.超声心动图对感染性心内膜炎的临床诊断价值[J].中华医院感染学杂志,2015,25(12):2772-2773,2810.
[10] 王辉,张抒扬,田庄,等.早期手术对左心感染性心内膜炎长期预后的影响[J].中华内科杂志,2014,53(6):450-454.
[11] 陈勇,刘双,谢江,等.右心感染性心内膜炎心内膜炎致脓毒性肺栓塞33例的临床特点与治疗[J].中国感染与化疗杂志,2013,13(2):100-105.
[12] 方文宾,王文标,梁亚非.感染性心内膜炎患者病原菌分布与耐药性分析[J].中华医院感染学杂志,2015,25(10):2202-2204.
[13] HATFIB G,HOEN B,TOMOS P,et al.Guidelines on the prevention,diagnosis and treatment of infective endocarditis[J].Eur Heart J,2016,30(14):2369-2413.
[14] LI L,WANG H,WANG L,et al.Changing profile of infective endocarditis:a clinicopathologic study of 220 patients in a single medical center from 1998 through 2009[J].Tex Heart lnst J,2014,41(5):491-498.
[15] 何胜平,陈雅华,张振,等.感染性心内膜炎112例临床分析[J].南方医科大学学报,2013,33(2):279-281.
[16] 王鹏,卢静海,王贺玲,等.感染性心内膜炎368例临床分析[J].中华心血管病杂志,2014,42(2):140-144.
[17] MIRABEL M,RATTANAVONG S,FRICHITTHAVONG K,et al.Infective endocarditis in the Lao PDR:clinical characteristics and outcomes in a developing country[J].Int J Cardiol,2015,180:270-273.
[18] 饶希,吕晓菊,王晓辉.感染性心内膜炎205例诊断析评[J].中华心血管病杂志,2010,38(1):47-51.
[19] GOULD F K,DENNING D W,ELLIOTT T S,et al.Guidelines for the diagnosis and antibiotic treatment of endocarditis in adults:a report of the Working Party of the British Society for Antimicrobial Chemotherapy[J].J Antimicrob Chemother,2012,67(2):269-289.
[2] HARRISON J L,PRENDERGAST B D,HABIB G.The European society of cardiology 2009 guidelines on the prevention,diagnosis,and treatment of infective endocarditis:key messages for clinical practice[J].Pol Arch Med Wewn,2009,119(12):773-776.
[3] 谢红梅,胡必杰,周春妹,等.218例感染性心内膜炎临床和病因学特征及预后分析[J].中华内科杂志,2014,53(5):363-367.
[4] 张岩,孙寒松,胡盛寿,等.感染性心内膜炎104例的临床分析[J].中国胸心血管外科临床杂志,2013,20(5):604-606.
[5] BADDOUR L M,WILSON W R,BAYER A S,et al.Infective endocarditis in adults:diagnosis,antimicrobial therapy,and management of complications:a scientific statement for healthcare professionals from the american heart association[J].Circulation,2015,132(15):1435-1486.
[6] 中华医学会儿科学分会心血管学组.小儿感染性心内膜炎的诊断标准(试行)[J].中华儿科杂志,2001,39(5):310.
[7] CAHILL T J,PRENDERGAST B D.Infective endocarditis[J].Lancet,2016,387(10021):882-893.
[8] 梁峰,胡大一,沈珠军,等.2015年欧洲心脏病学会关于感染性心内膜炎诊断及治疗指南的解读[J].中国医院用药评价与分析,2017,17(2):160-166.
[9] 钱纪江,章瑾,孟德莉,等.超声心动图对感染性心内膜炎的临床诊断价值[J].中华医院感染学杂志,2015,25(12):2772-2773,2810.
[10] 王辉,张抒扬,田庄,等.早期手术对左心感染性心内膜炎长期预后的影响[J].中华内科杂志,2014,53(6):450-454.
[11] 陈勇,刘双,谢江,等.右心感染性心内膜炎心内膜炎致脓毒性肺栓塞33例的临床特点与治疗[J].中国感染与化疗杂志,2013,13(2):100-105.
[12] 方文宾,王文标,梁亚非.感染性心内膜炎患者病原菌分布与耐药性分析[J].中华医院感染学杂志,2015,25(10):2202-2204.
[13] HATFIB G,HOEN B,TOMOS P,et al.Guidelines on the prevention,diagnosis and treatment of infective endocarditis[J].Eur Heart J,2016,30(14):2369-2413.
[14] LI L,WANG H,WANG L,et al.Changing profile of infective endocarditis:a clinicopathologic study of 220 patients in a single medical center from 1998 through 2009[J].Tex Heart lnst J,2014,41(5):491-498.
[15] 何胜平,陈雅华,张振,等.感染性心内膜炎112例临床分析[J].南方医科大学学报,2013,33(2):279-281.
[16] 王鹏,卢静海,王贺玲,等.感染性心内膜炎368例临床分析[J].中华心血管病杂志,2014,42(2):140-144.
[17] MIRABEL M,RATTANAVONG S,FRICHITTHAVONG K,et al.Infective endocarditis in the Lao PDR:clinical characteristics and outcomes in a developing country[J].Int J Cardiol,2015,180:270-273.
[18] 饶希,吕晓菊,王晓辉.感染性心内膜炎205例诊断析评[J].中华心血管病杂志,2010,38(1):47-51.
[19] GOULD F K,DENNING D W,ELLIOTT T S,et al.Guidelines for the diagnosis and antibiotic treatment of endocarditis in adults:a report of the Working Party of the British Society for Antimicrobial Chemotherapy[J].J Antimicrob Chemother,2012,67(2):269-289.
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