肝硬化及重型肝炎并发败血症患者病原菌分布及耐药性分析  

Distribution and Drug Resistance of Pathogens in Patients of Liver Cirrhosis and Fulminant Hepatitis Complicating Septicemia

作　　者：沈华江[1] 王志炜[1] 郭亚光[1] 金法祥[1] 

机构地区：[1]绍兴市第六人民医院肝病科,浙江绍兴312000

出　　处：《中华医院感染学杂志》2010年第7期953-955,共3页Chinese Journal of Nosocomiology

摘　　要：目的探讨肝硬化及重型肝炎合并败血症患者病原菌分布及耐药情况，为临床诊断和治疗败血症提供可靠的依据。方法以医院2001年1月～2008年12月，诊断为肝硬化及重型肝炎合并败血症血液病原菌培养阳性的住院患者为研究对象，对150株病原菌进行鉴定和耐药分析。结果150株病原菌中，革兰阴性杆菌、革兰阳性球菌、真菌分别占54．0％、43．3％、2．7％，分离菌株前4位依次为大肠埃希菌、凝固酶阴性葡萄球菌、肺炎克雷伯菌、酿脓链球菌；药敏结果对常见的革兰阴性杆菌、革兰阳性球菌耐药较低的药物有碳青酶烯类、加酶抑制剂和万古霉素。结论导致肝硬化及重型肝炎合并败血症的病原菌分布以革兰阴性杆菌为主，病原菌中多药耐药菌常见，需对败血症病原菌及其耐药性进行动态监测，以便临床根据细菌培养及药敏结果及时合理选用抗菌药物。OBJECTIVE To evaluate the distribution and drug resistance of pathogens in patieats of liver cirrhosis and fulminant hepatitis complicating septicemia, and provide the credible evidence with the clinic diagnosis and the treatment of septicemia. METHODS Totally 146 cases of hospitalized patients of liver cirrhosis and fulminant hepatitis with septicemia were addmitted to our hospital between Jan,2001 and Dec, 2008. Blood of all cases were cultured. The 150 strains of pathogens were identified and the drug resistance was analyzed. RESULTS A total of 150 strains were isolated from 146 patients. Gram-negative bacilli, Gram-positive cocci and fungus accounted for 54.0%, 43.3%, 2.7%, respectively. The top four pathogens were Escherichia coli, coagulase negative Staphylococcus, Klebsiella pneumoniae and Streplococcus viridans. The drug to which had relatively low resistance for the Gram-negative bacilli and the Gram-positive cocci were the carbapenems, the enzyme inhibitors and vancomycin. CONCLUSIONS The Gram-negative bacilli are common and show multiple drug resistance. It is necessary to monitor the distribution of pathogens and drug resistance. In clinic, antimicrobial agents for the septicemia treatments should be chosen reasonably based on the results of bacteria culture and drug sensitive test.

关 键 词：肝硬化 重型肝炎 败血症 病原菌 耐药性 

分 类 号：R378[医药卫生—病原生物学]