抗生素治疗厌氧菌性心包炎的研究进展.pdfVIP

58 WorldNotesonAntibiotics2010，Vo1．31，No．2 ， 抗生素治疗厌氧菌性心包炎的研究进展 邓 万俊 (南华大学附属南华医院心内科，湖南衡阳421002) 摘 要：自厌氧菌性心包炎患者中分离出的主要致病厌氧菌包括革兰阴性杆菌(大多为脆弱拟杆菌属)、消化链球菌 属、梭杆菌、梭形杆菌属、双岐杆菌属及放线菌属等。引起厌氧菌性心包炎的途径主要是：(1)邻近感染灶的播散 ； (2)心脏 内感染灶的播散；(3)血行播散 ；(4)胸部贯通伤或心胸外科手术时的直接种植。由于近年来厌氧革兰阴性杆菌 对青霉素及其他抗生素的耐药增加，因此厌氧菌的鉴定与药物敏感试验对厌氧菌性心包炎的治疗至关重要。厌氧菌性 心包炎内科治疗主要是应用对致病厌氧菌有效的抗生素。 关键词：心包炎；厌氧菌；抗生素 中图分类号：R978．1 文献标识码：A 文章编号：1001—8751(2010)02—0058—05 ProgressintheTreatmentofPericarditisCausedby AnaerobicBacteria DENGWan-jun (DeptofCardiology,AffiliatedNanhuaHospitalofNanhuaUniversity,Hengyang421002，China) Abstract：Thisreview describesprogressinthemanagementofpericarditisassociatedwith anaerobicbacterial infection．ThepredominantanaerobesisolatedfrompatientswithpericarditisareGram—negativebacilli(mostlyBacteroides fragilis)，Peptostreptococcus，Clostridium，Fusobacterium，Bifidobacterium andActinomycesspp．Theprimaryfactors thatmayberesponsibleforthedevelopmentofanaerobicpericarditisinclude：(I)pathogensspreadfromacontiguous focusofinfection，(2)pathogensspreadfrom afocusofinfectionwithintheheart，(3)haematogenousinfection，and(4) directinoculationasaresultofathoracicpenetratinginjuryorcardiothoracicsurgery．Inrecentyears，penicillin—andother antimicrobial—resistanceofanaerobicGram-negativebacillihavesignificantly increased，identificationandantimicrobial susceptibilitytesting，therefore，becomeessentialofrthemanagementofinfectionscausedbyanaerobicbacteria．The mainstayofmedicaltreatmentofrpericarditisassociatedwithanaerobesistheantibiotictherapyeffectiveagainstabove-