摘要： 目的 探讨草绿色链球菌引起感染性心内膜炎（IE）的病原学特征和临床特点。方法 选取2016年6月至2021年12月中国医科大学附属第一医院收治的57例血培养阳性IE患者的临床资料。分析其病原菌构成及草绿色链球菌的耐药情况；将患者分为草绿色链球菌组和非草绿色链球菌组，对2组临床特点进行对比。结果 血培养分离病原菌，草绿色链球菌32株，占56.1%，其中戈登链球菌株数最多（11株）。草绿色链球菌耐药性分析结果显示，草绿色链球菌对红霉素和阿奇霉素的耐药性最高，分别为81.3%和78.1%；未见青霉素G、万古霉素、利奈唑胺耐药菌株，青霉素G中介率达28.1%。临床特点分析结果显示，2组先天性心脏病（非主动脉二叶畸形先心病）、入院前病程、二尖瓣赘生物以及心功能不全结果有统计学差异（P < 0.05）。结论 草绿色链球菌是IE的最常见致病菌；青霉素仍是经验治疗草绿色链球菌IE的首选药物；病程长、生长二尖瓣赘生物和未发生心功能不全的临床特点对IE患者发生草绿色链球菌感染的病原体评估具有一定的提示作用。

草绿色链球菌感染性心内膜炎的病原学特征及临床特点分析

吴雨声, 田素飞, 褚云卓

中国医科大学附属第一医院检验科, 沈阳 110001

收稿日期:2022-05-30出版日期:2023-02-28发布日期:2023-02-04
通讯作者:褚云卓E-mail:cyz@163.com
作者简介:吴雨声(1990-),女,医师,硕士.



关键词: 感染性心内膜炎, 草绿色链球菌, 病原学特征, 临床特点
Abstract: Objective To investigate the pathogenic characteristics and clinical features of infective endocarditis (IE) caused by Viridans streptococci. Methods The clinical data of 57 patients with blood culture-positive IE admitted to the First Hospital of China Medical University from June 2016 to December 2021 were retrospectively analyzed. The composition of pathogenic bacteria and drug resistance of Viridans Streptococcus were analyzed;the patients were divided into the Viridans Streptococcus and non-Viridans Streptococcus groups, and the clinical characteristics of the two groups were compared and analyzed. Results In total, 32 strains of Viridans streptococci were isolated from blood cultures, accounting for 56.1%, among which Streptococcus gordonii (11 strains) had the highest number of strains. Analysis of Viridans streptococci drug resistance showed the highest resistance to erythromycin and azithromycin, accounting for 81.3% and 78.1% respectively, and no resistance to penicillin G, vancomycin, and linezolid, but the intermediation rate to penicillin G was 28.1%. Analysis of clinical features revealed that outcomes associated with congenital heart disease (non-aortic bilobar malformation preconditioning), pre-admission duration days, mitral valve vegetation, and cardiac dysfunction were statistically different between the two groups (P < 0.05). Conclusion Viridans streptococci is the most common causative bacteria of infective endocarditis. Penicillin remains the first choice for treating IE caused by Viridans streptococci. Clinical features, including a long disease duration, mitral vegetation, and absence of cardiac dysfunction can be helpful for identifying occurrence of Viridans streptococci infections in patients with IE.
Key words: infective endocarditis, Viridans streptococci, pathogenic features, clinical
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