肝硬化患者产超广谱β-内酰胺酶大肠埃希菌血液感染的分析  

Analysis for bloodstream infections caused by extended-spectrum β-lactamase-producing Escherichia coli in patients with liver cirrhosis

作　　者：张思泉[1] 叶卫江[1] 朱明利[2] 王飞[1] 刘华锋[3] 

机构地区：[1]杭州市第六人民医院重痱监护病房,310014 [2]杭州市第六人民医院开放实验室 [3]杭州市第六人民医院统计室

出　　处：《国际流行病学传染病学杂志》2009年第5期299-302,共4页International Journal of Epidemiology and Infectious Disease

摘　　要：目的 分析肝硬化患者产超广谱β-内酰胺酶（ESBLs）大肠埃希菌（大肠杆菌）血液感染的危险因素及其对常用抗菌药物的耐药性，为临床治疗提供参考。方法对2001年9月-2008年12月我院30例产ESBLs的大肠埃希菌血液感染肝硬化患者（A组）与60例非产ESBLs的大肠埃希菌血液感染肝硬化患者（B组）进行病例一对照研究。结果A组重型肝炎及继发性败血症发生率明显高于B组（P〈0．05），既往三代头孢菌素、β-内酰胺酶抑制剂复合制剂或氟喹诺酮类抗菌药物使用率均高于对照组（P〈0．05）。产ESBLs大肠埃希菌除亚胺培南／西司他丁、头孢哌酮／舒巴坦、哌拉西林／他唑巴坦外，对各类抗菌药物呈现了较为普遍的耐药性。结论严重肝功能损伤、使用过三代头孢菌素、β-内酰胺酶抑制剂复合制剂或氟喹诺酮类抗菌药物是产ESBLs大肠埃希菌血液感染的危险因素。对有产ESBLs大肠埃希菌败血症的肝硬化高危患者，应首选亚胺培南／两司他丁、头孢哌酮／舒巴坦、哌拉西林／他唑巴坦作为经验性治疗。Objective To investigate the risk factors for bloodstream infections caused by extended-spectrum β-lactamases（ ESBLs）-producing Escherichia coli in patients with liver cirrhosis, and provide reference for clinical therapy. Methods An exploratory case control study was used, in which 30 cases of liver cirrhosis with bacteraemia caused by ESBLs-producing E. coli （Group A）were compared with 60 eases of liver cirrhosis with baeteraemia caused by non-ESBLs-pmdueing E. coli（ Group B）. Results Previous use ratio of third generation cephalosporins, combinations of β-lactams and β-lactamase inhibitors or fluoroquinolones and the incidence of chronic severe hepatitis and secondary septicamia were higher in group A than in group B （P 〈 0.05）. In addition to imipenem-eilastatin, cefoperazone-sulbactam, piperacillin-tazobactam, ESBLs-producing E. coli was usually resistant to most antimicrohial agents. Conclusions Previous use of third generation cephalosporlns, combinations of β-lactams and β-lactamase inhibitors or fluoroquinolones and severe liver dysfunction are risk-factors for ESBLs-producing E. coli bacteraemia among patients with liver cirrhosis. These findings may help in identifying patients with liver cirrhosis at high risk for bloodstream infection caused by ESBLs- producing E. coll. When the patients with liver cirrhosis are at risk for bloodsteam infection caused by ESBLs-producing E. coli, above-mentioned antimicrobial agents should be. considered the selection as empirical trealment.

关 键 词：大肠杆菌 超广谱Β-内酰胺酶 危险因素 肝硬化 败血症 耐药 

分 类 号：R446.5[医药卫生—诊断学] R575.2[医药卫生—临床医学]