2015—2020年南京地区感染性心内膜炎病原菌流行病学特征及耐药性分析

Epidemiological characteristics and drug resistance analysis of pathogenic bacteria of infective endocarditis in Nanjing area in 2015-2020

摘要:

目的 针对南京地区近五年来感染性心内膜炎病原菌流行病学特征及耐药性进行分析和讨论，以利预防和诊治。方法 研究分析南京地区2015~2020年间感染性心内膜炎病例样本220例纳入分析。收集并分析病原菌的分布特点；同时收集耐药情况信息，并讨论病原菌分布与耐药性之间的潜在关联。结果 本研究中纳入分析的患者男女比例为（143/77）,年龄多集中在41~60岁,有195例患者合并心脏基础疾病(88.64%)。全部220例患者共送检血液标本检出病原菌共1132株，主要革兰阳性菌（1007株，88.96%）：为草绿色链球菌725株（725/1132,64.05%）,金黄色葡萄球菌124株（124/1132,10.95%），表皮葡萄球菌96株（96/1132,8.48%），其他（人葡萄球菌等）62株（62/1132,5.48%）；主要革兰阴性菌（125株, 11.04%）为铜绿假单胞菌73株（73/1132,6.45%），大肠埃希菌52（52/1132,4.59%）。且在不同年龄和性别受试对象分离出的菌株中，分布差别均与合计趋势一致，P均>0.05，差异无统计学意义。革兰阳性菌中，链球菌对青霉素、苯唑西林、万古霉素等抗生素敏感；金黄色、表皮葡萄球菌对万古霉素具有敏感性，对苯唑西林、青霉素具有更多的耐药性；革兰阴性菌对阿米卡星和美罗培南的耐药性较低，P均<0.05，差异具有统计学意义。结论 接诊感染性心内膜炎患者，可依据病原菌的类型及对应的耐药特征，指导合理选择抗菌药物。

Abstract:

Objective To analyze and discuss the epidemiological characteristics and drug resistance of pathogenic bacteria of infective endocarditis in Nanjing in the past five years, and to provide reference for the prevention and treatment of infective endocarditis. Methods A total of 220 infective endocarditis cases in Nanjing area from 2015 to 2020 were included in the analysis. The distribution characteristics of pathogens were collected and analyzed. Information on drug resistance was also collected, and the potential relationship between pathogen distribution and drug resistance was explored. Statistical analysis was performed using SPSS 19.0. Results The ratio of male to female patients included in this study was 143:77, and most of them were aged from 41 to 60 years old. There were 195 patients with underlying cardiac diseases (88.64%). A total of 1132 pathogenic bacteria were detected in the blood samples of all 220 patients, among which 1 007 were mainly gram-positive bacteria (88.96%): 725 strains of Streptococcus viridans (725/1 132, 64.05%), 124 strains of Staphylococcus aureus (124/1 132, 10.95%), 96 strains of Staphylococcus epidermidis (96/1 132, 8.48%), and 62 strains (62/1 132, 5.48%) of others (Staphylococcus human, etc.); the main gram-negative bacteria ( a total of 125 strains , 11.04%) were 73 strains of Pseudomonas aeruginosa (73/1 132, 6.45%) and 52 strains of Escherichia coli (52/1 132, 4.59%). Among the strains isolated from subjects of different ages and genders, the distribution difference was consistent with the total trend, and there was no significant difference (all P>0.05). Among gram-positive bacteria, Streptococcus was sensitive to antibiotics such as penicillin, oxacillin, and vancomycin. Staphylococcus aureus and S. epidermidis were sensitive to vancomycin and resistant to oxacillin and penicillin. Gram-negative bacteria were less resistant to amikacin and meropenem. All these differences were statistically significant (all P<0.05). Conclusion For patients with infective endocarditis, antibiotics should be selected reasonably according to the type of pathogenic bacteria and the corresponding drug resistance characteristics.