金黄色葡萄球菌性心内膜炎29例临床分析

蒋妮; 周宝桐; 范洪伟; 苗齐; 刘晓清; 李太生

doi:10.16766/j.cnki.issn.1674-4152.002939

金黄色葡萄球菌性心内膜炎29例临床分析

doi: 10.16766/j.cnki.issn.1674-4152.002939

蒋妮^{1, 2},
周宝桐^1, ,,
范洪伟¹,
苗齐³,
刘晓清¹,
李太生¹

1.
中国医学科学院中国协和医科大学北京协和医院感染内科，北京 100027
2.
兰州大学第一医院感染科，甘肃兰州 730000
3.
中国医学科学院中国协和医科大学北京协和医院心外科

基金项目:

甘肃省卫生行业科研计划项目 GSWSKY2017-45

甘肃省科技计划项目 20JR5RA364

详细信息

通讯作者:
周宝桐，E-mail: zhoubt@pumch.cn

中图分类号: R542.41
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出版历程
- 收稿日期: 2022-03-09
- 网络出版日期: 2023-05-31

Clinical Analysis of 29 cases of Staphylococcus aureus endocarditis

1.
Department of Infectious Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100027, China

摘要

摘要: 目的分析金黄色葡萄球菌性心内膜炎的临床特点，以提高临床医生对本病的治疗水平。方法回顾性分析2012年1月—2022年1月北京协和医院住院治疗的金黄色葡萄球菌性心内膜炎患者，分析流行病学特征、临床特征、实验室及影像学检查结果、治疗措施及预后等资料。结果金黄色葡萄球菌性心内膜炎共有29例患者，男性16例，女性13例，年龄17~82岁。其中甲氧西林敏感金黄色葡萄球菌(methicillin sensitive Staphylococcus aureus, MSSA)16例(MSSA组), 甲氧西林耐药金黄色葡萄球菌(methicillin resistant Staphylococcus aureus, MRSA)13例(MRSA组)。患者中7例（24.14%）有先天性心脏病，19例（65.52%）有基础慢性病，4例（13.79%）既往行心外科手术。有半数患者病程初期出现皮肤屏障破坏，所有患者均在病程中出现发热，18例患者（62.07%）发现心脏杂音，22例患者（75.86%）发现迁徙病灶，以化脓性心包炎和肺脓肿最多见，且MSSA组更易出现。患者均进行血培养，需氧瓶报阳时间为14.0(9.3, 25.5)h，厌氧瓶报阳时间为16.0（10.3, 37.5）h，MSSA培养阳性时间少于甲氧西林耐药金黄色葡萄球菌，Z=-2.289，P=0.022。13例患者心瓣膜赘生物大于10 mm，赘生物最常附着于主动脉瓣，共有11例（37.93%）。患者使用最多的抗生素为万古霉素与达托霉素，共19例（65.52%）接受手术治疗。最终好转21例（72.41%），病情进展、恶化8例（27.59%）。结论 SA感染的高危人群，出现长程发热，应进行细致心脏听诊，并尽早完成血培养、心脏超声检查，一旦确诊，及时的抗菌治疗和适时的外科手术可改善预后。
- 金黄色葡萄球菌 /
- 感染性心内膜炎 /
- 临床分析
Abstract: Objective To analyze the clinical characteristics of Staphylococcus aureus (SA) endocarditis, in order to improve the clinical treatment of this disease. Methods Patients with SA endocarditis hospitalized in Peking Union Medical College Hospital from January 2012 to January 2022 were retrospectively analyzed. The epidemiological characteristics, clinical characteristics, laboratory and imaging findings, therapeutic measures and prognosis were analyzed. Results A total of 29 patients with SA endocarditis were included. Among them, 16 were males and 13 were females, aged from 17 to 82 years. Among these patients, methicillin sensitive Staphylococcus aureus was found in 16 cases (MSSA group) and methicillin resistant Staphylococcus aureus was found in 13 cases (MRSA group). Seven (24.14%) had congenital heart disease, 19 (65.52%) had underlying chronic diseases, and 4 (13.79%) had a history of previous cardiac surgery. Half of the patients had skin barrier damage in the early stage, all patients had fever during the course of the disease, 18 (62.07%) patients had heart souffle, 22 (75.86%) patients had migration lesions, and most of these were suppurative pericarditis and lung abscess, which were more likely to occur in MSSA group. The positive time of MSSA culture was 14.0 (9.3, 25.5) h in aerobic bottle and 16.0 (10.3, 37.5) h in anaerobic bottle. The positive time of MSSA culture was less than that of MRSA group (Z=-2.289, P=0.022). There were 13 patients with cardiac valve grafts larger than 10 mm, and the grafts were most often attached to the aortic valve with a total of 11 cases (37.93%). The most commonly used antibiotics were vancomycin and daptomycin, and 19 cases (65.52%) received surgical treatment. In the end, the condition of 21 (72.41%) patients improved and 8 (27.59%) got worse. Conclusion In high-risk groups with SA infection and long-term fever, careful cardiac auscultation should be carried out, and blood culture and cardiac ultrasound should be completed as soon as possible. Once confirmed, timely antibacterial treatment and timely surgical operation may improve the prognosis.
- aphylococcus aureus /
- Infective Endocarditis /
- Clinical analysis

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表 1 29例IE患者基础疾病及临床表现特征

Table 1. Basic diseases and clinical features of 29 IE patients

项目	MSSA(16例)	MRSA(13例)	P值
存在危险因素	8(50.00)	6(46.15)	1.000
基础疾病[例(%)]
先心病	5(31.25)	2(15.38)	0.410
高血压	2(12.50)	4(30.77)	0.364
冠心病	3(18.75)	1(7.69)	0.606
房颤	1(6.25)	2(15.38)	0.573
系统性疾病	3(18.75)	1(7.69)	0.606
糖尿病	1(6.25)	2(15.38)	0.573
心血管手术史	0	4(30.77)	0.030
临床表现
发热(℃)	38.5~41.0	39.0~40.0
肺部感染[例(%)]	8(50.00)	8(61.5)	0.711
皮肤瘀点[例(%)]	8(50.00)	6(46.2)	1.000
心衰表现[例(%)]	8(50.00)	9(69.2)	0.451
呼吸障碍[例(%)]	4(25.00)	4(30.8)	1.000
肌肉关节脓肿[例(%)]	4(25.00)	6(46.2)	0.270
肾损伤[例(%)]	3(18.75)	6(46.2)	0.226
意识障碍[例(%)]	4(25.00)	7(53.9)	0.143
心脏杂音[例(%)]	10(62.50)	8(61.5)	1.000
肝脾肿大[例(%)]	0	2(15.4)	0.192
注：采用Fisher精确检验。

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表 2 22例具有迁徙病灶的IE患者迁徙病灶部位比较[例(%)]

Table 2. Comparison of migration lesions sites in 22 IE patients with migration lesions[cases(%)]

组别	例数	胸腔(心、肺)	脑、眼睛	骨、关节、肌肉	皮肤	腹腔(肾、脾)
MSSA组	13	13(81.25)	5(31.25)	3(18.75)	3(18.75)	3(18.75)
MRSA组	9	5(38.46)	7(53.85)	5(38.46)	4(30.77)	1(7.69)
P值		0.027	0.250	0.406	0.667	0.606

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表 3 29例IE患者治疗及结局

Table 3. Treatment and outcome of 29 IE patients

组别	例数	住院时间(x±s，d)	手术治疗[例(%)]	住院期间入住ICU[例(%)]	恶化、死亡[例(%)]
MSSA	16	33.4±24.3	10(62.50)	10(62.50)	4(25.00)
MRSA	13	33.5±16.6	9(69.23)	11(84.62)	4(30.77)
统计量		0.013^a
P值		0.990	1.000^b	0.238^b	1.000^b
注：^a为t值，^b为采用Fisher精确检验。

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