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目的研究先天性心脏病合并感染性心内膜炎患儿的病原菌种类,并分析其耐药性,为临床诊疗以及抗菌药物的选择提供参考。方法本院2010年9月至2016年8月收入院的先天性心脏病合并感染性心内膜炎患儿68例,通过血培养统计其病原菌种类及构成,并进行药敏试验。结果 98例患儿细菌血培养阳性38例,共分离出致病菌57株。其中革兰阳性菌41株,占71.93%,主要以草绿色链球菌多见,构成比为36.84%(21/57);革兰阴性菌16株,占28.07%,主要以大肠埃希菌为主,构成比为12.28%(7/57)。草绿色链球菌对阿米卡星、红霉素、克林霉素敏感性较低,对其他抗菌药物的敏感性均超过80%;金黄色葡萄球菌对复方新诺明、万古霉素、替考拉林、亚胺培南的敏感性均为100%,肠球菌对头孢吡肟、阿米卡星、复方新诺明、左氧氟沙星、万古霉素、替考拉林、亚胺培南敏感性均为100%,凝固酶阴性葡萄球菌对万古霉素、替考拉林、亚胺培南敏感性均为100%,大肠埃希菌对阿米卡星、亚胺培南敏感性均为100%。结论先天性心脏病合并感染性心内膜炎患儿的致病菌多数为革兰阳性球菌,且以草绿色链球菌为主。主要致病菌对万古霉素、替考拉林、亚胺培南均敏感性,但除草绿色链球菌外,其它病原菌对青霉素均不敏感。
Objective To study the pathogens of children with congenital heart disease complicated with infective endocarditis and to analyze the drug resistance of the patients with congenital heart disease and to provide references for the clinical diagnosis and treatment and the selection of antibacterial drugs. Methods Sixty-eight children with congenital heart disease complicated with infective endocarditis admitted to our hospital from September 2010 to August 2016 were enrolled in this study. The types and composition of pathogens in blood were counted and susceptibility tests were performed. Results A total of 38 cases of bacterial blood cultures were positive in 98 cases, and 57 pathogens were isolated. Gram-positive bacteria 41, accounting for 71.93%, mainly in Streptococcus viridans more common, the composition ratio was 36.84% (21/57); Gram-negative bacteria 16 strains, accounting for 28.07%, mainly to Escherichia coli Lord, the constituent ratio was 12.28% (7/57). Streptococcus viridans against amikacin, erythromycin, clindamycin less sensitive to other antibacterials were more than 80%; Staphylococcus aureus cotrimoxazole, vancomycin, The sensitivity of kalalalin and imipenem were both 100%. The sensitivity of enterococci to cefepime, amikacin, cotrimoxazole, levofloxacin, vancomycin, teicoplanin, imipenem Were 100%, coagulase-negative Staphylococcus aureus vancomycin, teicoplanin, imipenem sensitivity were 100%, Escherichia coli amikacin, imipenem were 100 %. Conclusions Most of the pathogenic bacteria in children with congenital heart disease complicated with infective endocarditis are Gram-positive cocci, and mainly Streptococcus viridans. The main pathogens of vancomycin, teicoplanin, imipenem are sensitive, but the weed Streptococcus, the other pathogens are not sensitive to penicillin.