感染性心内膜炎血培养病原菌的分布及耐药性分析

摘要

Objective To investigate the distribution and antibiotic resistance of pathogens in blood culture in infective endocarditis and give guidence of rational use of antibiotics in clinic. Methods Bacteria were identified by VITKK-2-Compact system. All of the isolates were tested by Kirby-Bauer susceptibility method. Vancomycin to Staphylococcus were tested by E-Test. The data were analyzed by Whonet 5. 6. Results 141 strains of pathogenic bacteria were isolated. Streptococcus viridans(n = 53) ,Coagulase negative Staphylococcus(n = 34) and Staphylococcus aureus(n=18) were the three most common bacteria. Resistance rates of Streptococcus viridans to both of erythromycin and clindamycin were 50%. Resistance rates to penicillin, ceftriaxone, cefotaxime and levo-floxacin were less than 10%. Resistance rates of coagulase negative Staphylococcus to penicillins, cephalosporins and erythromycin were more than 80%. Resistance rates of Staphylococcus aureus to penicillins was up to 94. 4% ,Which to levofloxacin and erythromycin were 27. 8% and 22. 2% respectively and to other drugs were less than 20%. The incidence of MRCNS and MRSA were 85. 3% and 11. 1% respectively. Conclusion Clinicians should pay close attention to the changes and resistance of pathogenic bacteria and use antibiotics rationally.%目的 对感染性心内膜炎患者血培养分离菌的分布及对常用抗菌药物的耐药性进行分析,为临床合理选用抗菌药物提供依据.方法 采用VITEK-2-Compact系统鉴定细菌,药敏试验采用纸片扩散法,万古霉素对葡萄球菌的药敏试验采用E-Test方法,数据分析应用WHONET 5.6 软件.结果 共分离141株病原菌,草绿色链球菌、凝固酶阴性葡萄球菌和金黄色葡萄球菌为最常见病原菌,分别为53株、34株和18株.草绿色链球菌对红霉素、克林霉素的耐药率均为50%,对青霉素、头孢曲松、头孢噻肟和左氧氟沙星的耐药率均低于10%.凝固酶阴性葡萄球菌对青霉素类、头孢菌素类及红霉素的耐药率均大于80%.金黄色葡萄球菌对青霉素的耐药率最高为94.4%,对左氧氟沙星和红霉素的耐药率分别为27.8%和22.2%,对其他抗菌药物的耐药率均小于20%.耐甲氧西林的凝固酶阴性葡萄球菌和耐甲氧西林的金黄色葡萄球菌的发生率分别为85.3%和11.1%.结论 临床医生要密切关注分离菌的变迁及耐药性情况,合理使用抗菌药物.