Analysis of the distribution characteristics of pathogenic bacteria in patients with infective endocarditis and the diagnostic value of echocardiography
Objective To explore the types and distribution patterns of pathogenic bacteria in patients with infective endocarditis and the application value of echocardiography in the process of diagnosing this disease.Methods A retrospective analysis method was adopted to sort out the clinical data of 126 patients with infective endocarditis diagnosed in this hospital from 2021 to 2023,to analyze the types of pathogenic bacteria and the drug-resistance rate,and at the same time compare the coincidence rate between the echocardiography examination results and the surgical or pathological diagnosis to evaluate its diagnostic efficacy.Results Among the 126 patients with infective endocarditis,a total of 126 strains of pathogenic bacteria were isolated,including 80 strains of Gram-positive bacteria,36 strains of Gram-negative bacteria and 10 strains of fungi.Among the Gram-positive bacteria,Streptococcus viridans and Staphylococcus aureus were predominant;among the Gram-negative bacteria,Escherichia coli and Klebsiella pneumoniae were predominant;and the main fungus was Candida albicans.88.89％of the patients had native valve endocarditis,and the rest had prosthetic valve endocarditis.There was no significant difference in the composition of pathogenic bacteria between the two groups.Streptococcus viridans had a high resistance rate to erythromycin,clindamycin,and azithromycin,but was sensitive to penicillin and had not developed resistance to vancomycin and linezolid.S.aureus also had a high resistance rate to penicillin,erythromycin,clindamycin,and azithromycin,and was also not resistant to vancomycin and linezolid.There were significant differences in the resistance rates of the two bacteria to penicillin and gentamicin(P＜0.05).Among the 126 patients with infective endocarditis,51 cases had congenital heart diseases,accounting for 40.48％.Among them,ventricular septal defect accounted for 26.19％,patent ductus arteriosus accounted for 8.73％,and pulmonary valve stenosis accounted for 5.56％.There were 38 patients with rheumatic heart disease,accounting for 30.16％,with mitral valve lesions accounting for 20.63％and aortic valve lesions accounting for 9.52％.There were 18 patients with non-rheumatic heart diseases,accounting for 14.29％,with mitral regurgitation accounting for 10.32％and aortic regurgitation accounting for 3.97％.There were 5 patients without underlying heart diseases,accounting for 3.97％.There were 14 patients after valve replacement surgery,accounting for 11.11％.Vegetations were found by echocardiography in all patients.Among them,76 cases had vegetations≤ 10 mm,accounting for 60.32％;37 cases had vegetations of 11-15 mm,accounting for 29.37％;11 cases had vegetations of 16-20 mm,accounting for 8.73％;2 cases had vegetations≥21 mm,accounting for 1.59％.The vegetations were mainly distributed on the mitral valve(34.13％),tricuspid valve(10.32％),aorta(38.10％)and pulmonary valve(17.46％).Among patients with congenital heart diseases,vegetations on the pulmonary valve were in the majority;among patients with rheumatic heart diseases,vegetations on the aortic valve were in the majority;among patients with non-rheumatic heart diseases and those after valve replacement surgery,vegetations on the aorta were in the majority;among patients without underlying heart diseases,vegetations on the mitral valve were in the majority.Both echocardiography and surgery showed that there were vegetations in 126 patients,with a diagnosis rate of 100％.Complications were detected in 95 patients,and 75 cases were confirmed during surgery,with a diagnosis rate of 78.95％.Conclusion The pathogenic bacteria of infective endocarditis were widely distributed.In clinical treatment,it was crucial to rationally select antibiotics and adjust the treatment plan according to the results of drug susceptibility.Echocardiography played a vital role in the diagnosis of this disease.It can not only accurately detect vegetations but also assist in judging the severity of the disease and the presence of complications.Therefore,strengthening the monitoring of pathogenic bacteria resistance and combining with examination methods such as echocardiography will help improve the comprehensive treatment effect of infective endocarditis.
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