McCarthy V P, Cho C T, Diehl A M, Ramsey B W
Clin Pediatr (Phila). 1979 May;18(5):263-6. doi: 10.1177/000992287901800501.
Bacterial endocarditis remains a formidable diagnostic and therapeutic problem for clinicians. Streptococcus viridans still accounts for 45 to 50 per cent of all cases and between 5 to 10 per cent of all clinical isolates of Streptococcus viridans from patients with bacterial endocarditis may be relatively resistant to penicillin. The case of a 9-year-old child with Tetralogy of Fallot and a Waterston shunt who subsequently developed bacterial endocarditis due to penicillin-resistant Streptococcus viridans following failure of oral penicillin dental prophylaxis is presented. In the face of penicillin resistance, additional considerations for workup, including microbiological assays for antimicrobial synergism become necessary in the selection of a therapeutic regimen.
对临床医生而言，细菌性心内膜炎仍然是一个棘手的诊断和治疗难题。草绿色链球菌仍占所有病例的45%至50%，在细菌性心内膜炎患者中，所有临床分离出的草绿色链球菌菌株中有5%至10%可能对青霉素相对耐药。本文介绍了一名9岁患有法洛四联症并接受沃特斯顿分流术的儿童病例，该患儿在口服青霉素进行牙科预防失败后，因对青霉素耐药的草绿色链球菌而患上细菌性心内膜炎。面对青霉素耐药情况，在选择治疗方案时，进行进一步检查的其他考虑因素变得必要，包括进行抗菌协同作用的微生物学检测。
