感染性心内膜炎老年患者的临床特征及病原学分析

Clinical features and etiological analysis of elderly patients with infective endocarditis

摘要:

目的分析感染性心内膜炎（IE）老年患者的病原学和临床特征，为该病的预防和治疗提供科学依据。方法选取2015 年3 月-2016 年2 月上海市第八人民医院收治的IE老年患者96 例，对其采动脉血，进行细菌培养，使用Phoenix-100全自动细菌鉴定/药敏系统进行病原学鉴定。结果96 例IE患者中，病变位置在左心者76 例（79.17%）；病变位置在右心者7 例（7.29%）；病变位置在左右心者7 例（7.29%）；病变位置不明确者6 例（6.25%）；在上述96 例患者中，检出病原菌45 株，以酿脓链球菌为主，有25 株占55.6%；伴有心脏基础疾病者46 例（47.92%）。在多因素分析中，血红蛋白<90g/L和医院感染是IE老年患者的主要不安全性因素，而对其采取手术治疗是安全性因素。结论酿脓链球菌是IE 老年患者的主要病菌，应预防控制其危险因素，手术治疗是保护性因素。

Abstract:

Objective To analyze the etiology and clinical characteristics of elderly patients with infective endocarditis, and to provide scientific evidence for the prevention and treatment of the disease. Methods Ninety-six elderly patients with infective endocarditis, who were treated in Shanghai Eighth People's Hospital from March 2015 to February 2016, were selected, and arterial blood was collected for bacterial culture. The pathogens were identified by Phoenix-100 automatic bacterial identification/drug sensitive system. Results In the 96 patients, 76 cases (79.17%) had lesions located in the left heart, 7 cases (7.29%) had lesions in the right heart, 7 cases (7.29%) had lesions in both left and right hearts, 6 cases (6.25%) had uncertain lesion location. Among the 96 cases, 45 bacterial strains were found, mainly Streptococcus pyogenes(25 strains,55.56%). Underlying heart diseases were found in 46 cases accounting for 47.92%. In the multivariate analysis, hemoglobin < 90 g/L and hospital infections were the major factors of insecurity for the elderly patients with infective endocarditis, and surgical treatment was the safety factor. Conclusions Infective endocarditis is a serious threat to the life of elderly patients. Streptococcus pyogenes is the major pathogen,so early diagnosis, rational use of antibiotics and surgical treatment have good effect.