感染性心内膜炎手术患者病原菌分布、耐药特征及抗感染方案分析OA

Objective To clarify the composition of pathogens,antimicrobial resistance profiles and current status of clinical antibiotic use in patients with infective endocarditis(IE),so as to provide evidence-based rationale for optimizing the initial anti-infective regimens for IE.Methods The clinical data of IE patients who received surgical treatment at Xiangya Hospital,Central South University from January 2020 to April 2025 were retrospectively collected,and the baseline characteristics,pathogen distribution,antimicrobial susceptibility results,anti-infective regimens and prognosis were analyzed.Results Among the 338 patients,198 cases(58.58%)were positive for etiology,and a total of 203 strains of pathogens were isolated.Streptococcus spp.were identified as the predominant pathogens in both blood cultures and vegetation cultures,accounting for 64.04%(130/203),with a penicillin resistance rate of 2.13%(2/94).Staphylococcus accounted for 16.75%(34/203),with an oxacillin resistance rate of 40.00%(10/25);Enterococcus accounted for 6.90%(14/203),with a high-level aminoglycoside resistance rate of 36.36%(4/11).In empirical anti-infection treatment,the utilization rate of piperacillin-tazobactam was 21.21%(28/132),which decreased to 6.94%(10/144)after the drug sensitivity results were confirmed,while the utiliza-tion rate of ceftriaxone increased from 21.21%(28/132)to 34.03%(49/144),with statistically significant differ-ences(P<0.05).A total of 305 patients were followed up for one year,288 cases(94.43%)survived,and 17 cases(5.57%)died.Conclusion Streptococcus spp.are the major pathogens among surgically treated IE patients in this region and maintain high susceptibility to penicillins.There is a tendency toward overuse of high-level broad-spectrum antibiotics in clinical empirical anti-infection treatment.It is recommended to prefer penicillins or ceftriax-one as the initial treatment regimen to delay bacterial drug resistance and improve patient prognosis.