Bacterial infection is common and accounts for major morbidity and mortality in cirrhosis. Patients with cirrhosis are immunocompromised and increased susceptibility to develop spontaneous bacterial infections, hospit...Bacterial infection is common and accounts for major morbidity and mortality in cirrhosis. Patients with cirrhosis are immunocompromised and increased susceptibility to develop spontaneous bacterial infections, hospital-acquired infections, and a variety of infections from uncommon pathogens. Once infection develops, the excessive response of pro-inflammatory cytokines on a pre-existing hemodynamic dysfunction in cirrhosis further predispose the development of serious complications such as shock, acute-on-chronic liver failure, renal failure, and death. Spontaneous bacterial peritonitis and bacteremia are common in patients with advanced cirrhosis, and are important prognostic landmarks in the natural history of cirrhosis. Notably, the incidence of infections from resistant bacteria has increased significantly in healthcare-associated settings. Serum biomarkers such as procalcitonin may help to improve the diagnosis of bacterial infection. Preventive measures(e.g., avoidance, antibiotic prophylaxis, and vaccination), early recognition, and proper management are required in order to minimize morbidity and mortality of infections in cirrhosis.展开更多
AIM: To investigate the microbiological characteristics and drug resistance in liver cirrhosis patients with spontaneous peritonitis.METHODS: We analyzed the data of patients with liver cirrhosis and abdominal infecti...AIM: To investigate the microbiological characteristics and drug resistance in liver cirrhosis patients with spontaneous peritonitis.METHODS: We analyzed the data of patients with liver cirrhosis and abdominal infection at the First Affiliated Hospital of Zhejiang University between January 2011 and December 2013. Pathogens present in the ascites were identified,and their sensitivity to various antibiotics was determined. RESULTS: We isolated 306 pathogenic bacteria from 288 cases: In 178 cases,the infection was caused by gram-negative strains(58.2%); in 85 cases,grampositive strains(27.8%); in 9 cases,fungi(2.9%); and in 16 cases,more than one pathogen. The main pathogens were Escherichia coli(E. coli)(24.2%),Klebsiella pneumoniae(18.9%),Enterococcus spp.(11.1%),and Staphylococcus aureus(7.5%). Of the 306 isolated pathogens,99 caused nosocomial infections and 207 caused community-acquired andother infections. The E. coli and K. pneumoniae strains produced more extended-spectrum β-lactamases in cases of nosocomial infections than non-nosocomial infections(62.5% vs 38%,P < 0.013; 36.8% vs 12.8%,P < 0.034,respectively). The sensitivity to individual antibiotics differed between nosocomial and non-nosocomial infections: Piperacillin/tazobactam was significantly more effective against non-nosocomial E. coli infections(4% vs 20.8%,P < 0.021). Nitrofurantoin had stronger antibacterial activity against Enterococcus species causing non-nosocomial infections(36.4% vs 86.3%,P < 0.009).CONCLUSION: The majority of pathogens that cause abdominal infection in patients with liver cirrhosis are gram-negative,and drug resistance is significantly higher in nosocomial infections than in non-nosocomial infections.展开更多
目的：调查替考拉宁治疗肝硬化患者肠球菌属感染致自发性腹膜炎患者的临床疗效和安全性，为临床治疗提供参考依据。方法回顾性分析2008年1月－2014年1月医院收治的73例肝硬化肠球菌属感染致自发性腹膜炎患者临床资料，均应用国产替考拉...目的：调查替考拉宁治疗肝硬化患者肠球菌属感染致自发性腹膜炎患者的临床疗效和安全性，为临床治疗提供参考依据。方法回顾性分析2008年1月－2014年1月医院收治的73例肝硬化肠球菌属感染致自发性腹膜炎患者临床资料，均应用国产替考拉宁治疗，疗程7～14 d ，观察其临床、细菌学疗效以及不良反应发生率。结果73例肝硬化肠球菌属感染致自发性腹膜炎患者临床表现均有不同程度的发热、腹胀、腹围增加、尿少等；经替考拉宁治疗后，治愈39例，治愈率53．4％，显效25例，显效率34．2％，有效8例，有效率11．0％，无效1例，无效率1．4％，总有效率98．6％；73例患者无1例出现与治疗相关的不良反应。结论肝硬化肠球菌属感染致自发性腹膜炎时应用替考拉宁临床效果佳、安全性好，值得在临床推广使用。展开更多
文摘Bacterial infection is common and accounts for major morbidity and mortality in cirrhosis. Patients with cirrhosis are immunocompromised and increased susceptibility to develop spontaneous bacterial infections, hospital-acquired infections, and a variety of infections from uncommon pathogens. Once infection develops, the excessive response of pro-inflammatory cytokines on a pre-existing hemodynamic dysfunction in cirrhosis further predispose the development of serious complications such as shock, acute-on-chronic liver failure, renal failure, and death. Spontaneous bacterial peritonitis and bacteremia are common in patients with advanced cirrhosis, and are important prognostic landmarks in the natural history of cirrhosis. Notably, the incidence of infections from resistant bacteria has increased significantly in healthcare-associated settings. Serum biomarkers such as procalcitonin may help to improve the diagnosis of bacterial infection. Preventive measures(e.g., avoidance, antibiotic prophylaxis, and vaccination), early recognition, and proper management are required in order to minimize morbidity and mortality of infections in cirrhosis.
基金Supported by Grants from the National Basic Research Program of China,973 Program,No.2013CB531401
文摘AIM: To investigate the microbiological characteristics and drug resistance in liver cirrhosis patients with spontaneous peritonitis.METHODS: We analyzed the data of patients with liver cirrhosis and abdominal infection at the First Affiliated Hospital of Zhejiang University between January 2011 and December 2013. Pathogens present in the ascites were identified,and their sensitivity to various antibiotics was determined. RESULTS: We isolated 306 pathogenic bacteria from 288 cases: In 178 cases,the infection was caused by gram-negative strains(58.2%); in 85 cases,grampositive strains(27.8%); in 9 cases,fungi(2.9%); and in 16 cases,more than one pathogen. The main pathogens were Escherichia coli(E. coli)(24.2%),Klebsiella pneumoniae(18.9%),Enterococcus spp.(11.1%),and Staphylococcus aureus(7.5%). Of the 306 isolated pathogens,99 caused nosocomial infections and 207 caused community-acquired andother infections. The E. coli and K. pneumoniae strains produced more extended-spectrum β-lactamases in cases of nosocomial infections than non-nosocomial infections(62.5% vs 38%,P < 0.013; 36.8% vs 12.8%,P < 0.034,respectively). The sensitivity to individual antibiotics differed between nosocomial and non-nosocomial infections: Piperacillin/tazobactam was significantly more effective against non-nosocomial E. coli infections(4% vs 20.8%,P < 0.021). Nitrofurantoin had stronger antibacterial activity against Enterococcus species causing non-nosocomial infections(36.4% vs 86.3%,P < 0.009).CONCLUSION: The majority of pathogens that cause abdominal infection in patients with liver cirrhosis are gram-negative,and drug resistance is significantly higher in nosocomial infections than in non-nosocomial infections.
文摘目的：调查替考拉宁治疗肝硬化患者肠球菌属感染致自发性腹膜炎患者的临床疗效和安全性，为临床治疗提供参考依据。方法回顾性分析2008年1月－2014年1月医院收治的73例肝硬化肠球菌属感染致自发性腹膜炎患者临床资料，均应用国产替考拉宁治疗，疗程7～14 d ，观察其临床、细菌学疗效以及不良反应发生率。结果73例肝硬化肠球菌属感染致自发性腹膜炎患者临床表现均有不同程度的发热、腹胀、腹围增加、尿少等；经替考拉宁治疗后，治愈39例，治愈率53．4％，显效25例，显效率34．2％，有效8例，有效率11．0％，无效1例，无效率1．4％，总有效率98．6％；73例患者无1例出现与治疗相关的不良反应。结论肝硬化肠球菌属感染致自发性腹膜炎时应用替考拉宁临床效果佳、安全性好，值得在临床推广使用。
