摘要
目的探讨重型肝炎与肝硬化患者医院感染病原菌的分布及耐药性,为临床抗感染选药提供依据。方法查阅重型肝炎与肝硬化继发医院感染的251例患者临床资料,感染菌株的分离、培养、鉴定遵照临床微生物检验规范进行试验操作;采用K-B法进行药敏检测,依据CLSI最新折点判断结果为敏感、中介、耐药,整个检验过程在室内质量控制合格的前提下进行。结果重型肝炎与肝硬化患者医院感染的主要部位是腹腔、呼吸道、泌尿道等,分别占27.6%、19.2%、16.9%;共分离出病原菌278株,其中革兰阴性菌195株占70.1%,革兰阳性菌60株占21.6%,真菌23株占8.3%,前4位病原菌依次为大肠埃希菌、肠球菌属、肺炎克雷伯菌、铜绿假单胞菌,分别占23.4%、17.6%、16.9%、11.9%;大肠埃希菌和肺炎克雷伯菌对亚胺培南、美罗培南100.0%敏感,对头孢哌酮/舒巴坦、阿米卡星较敏感,耐药率<15.4%,铜绿假单胞菌对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦较敏感,耐药率<18.2%;耐亚胺培南铜绿假单胞菌和鲍氏不动杆菌检出率分别为38.5%、33.3%;产超广谱β-内酰胺酶(ESBLs)大肠埃希菌和肺炎克雷伯菌检出率为56.3%;耐甲氧西林葡萄球菌(MRS)检出率为54.5%。结论早期干预和有效控制医院感染是救治重型肝炎与肝硬化患者的关键,建议尽量减少有创性诊疗手段,实施综合性干预,以提高临床治愈率,延长重型肝炎与肝硬化患者的生存期。
OBJECTIVE To approach the species of pathogenic bacteria causing nosocomial infections in the patients with severe hepatitis and liver cirrhosis and analyze the drug resistance so as to provide guidance clinical use of antibiotics. METHODS The clinical data of 251 severe hepatitis and liver cirrhosis patients complicated with secondary nosocomial infections were reviewed, then the isolation, culture, and identification of the pathogens were per-formed by referring to the criteria of clinical microorganism laboratory examination; the drug susceptibility testing was performed by using K-B method, the drug susceptibility, intermediate, and resistance were determined according to the latest breakpoints of CLSI, and the whole process of examination was carried out under the qualified indoor quality control. RESULTS Among the patients with severe hepatitis and liver cirrhosis, the patients with abdominal infections accounted for 27.6%, the patients with respiratory tract infections 19.2%, the patients with urinary tract infections 16. 9%. A total of 195 strains of pathogens have been isolated, including 195 （70. 1%） strains of gram-negative bacteria, 60 （21.6%） strains of gram-positive bacteria and 23 （8.3%） strains of fungi;the Escherichia coli, Enterococcus, Klebsiella pneurnoniae, and Pseudornonas aeruginosa ranked the top four species of pathogens, accounting for 23. 4%, 17. 6%, 16. 9%, and 11.9%, respectively. The drug susceptibility rates of the E. coli and K. pneurnoniae to imipenem and meropenem were 100.0%, and the drug resistance rates tocefoperazone-sulbactam and amikacin were less than 15.4 % ; the drug resistance rates of the P. aeruginosa to piperacillin-tazobactam and cefoperazone-sulbactam were less than 18.2%. The isolation rates of the imipenem-resistant P. aeruginosa and Acinetobacter baumannii were 38.5% and 33.3%, respectively; the isolation rates of the extended-spectrum β-lactamases （ESBLs）-producing E. coli and K. pneumoniae were 56.3% the isolation rate of the methieillin-resis
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2014年第17期4205-4207,共3页
Chinese Journal of Nosocomiology
基金
湖北省科技厅自然科学基金项目(2012FFC120)
关键词
重型肝炎
肝硬化
医院感染
耐药性
Severe hepatitis Liver cirrhosis Nosocomial infection
Drug resistance
