肝硬化患者气单胞菌败血症的临床特点和死亡因素分析  

Analysis of clinical features and risk factors for mortality in Aeromonas septicemia in patients with hepatic cirrhosis

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

机构地区：[1]浙江中医药大学附属第六医院重症监护病房,杭州310014 [2]浙江中医药大学附属第六医院统计室,杭州310014 [3]浙江中医药大学附属第六医院开放实验室,杭州310014

出　　处：《国际流行病学传染病学杂志》2010年第1期33-36,共4页International Journal of Epidemiology and Infectious Disease

摘　　要：目的研究肝硬化患者气单胞菌败血症的临床特点和死亡危险因素，为治疗提供依据。方法回顾性分析2001年9月至2008年9月我院29例（31例次）肝硬化并发气单胞菌败血症患者的临床资料、微生物学特点和死亡危险因素。同一患者间隔2个月以上发生的气单胞菌败血症被认为独立发生的2例败血症。结果29例患者共发生气单胞菌败血症31例次，有2例发生2次败血症。29例患者中乙型肝炎后肝硬化27例（合并原发性肝癌2例），酒精性肝硬化2例。31例次患者共培养气单胞菌32株，其中嗜水气单胞菌31株，温和气单胞菌1株。主要临床表现依次为是发热（96．8％）、腹痛（32．3％）、恶心及呕吐（32．3％）、腹泻（29．0％）等。1例为多病原体感染。3例在败血症发生48h内死亡。从采血行病原菌培养到死亡的平均时间为7．4d。感染性休克（偏回归系数1．649，RR=5．2，P〈0．01）是死亡的独立危险预测因子。气单胞菌对亚胺培南及哌拉西林／他唑巴坦的耐药率分别为51．6％和35．5％，对四代头孢菌素、氨基糖苷类、氟喹诺酮类抗菌药物敏感性较高。结论肝硬化患者有发热并怀疑气单胞菌感染时，尤其要注意对感染性休克的防治。四代头孢菌素、氨基糖苷类及氟喹诺酮类是目前治疗气单胞菌感染的首选抗菌药物。Objective To study the clinical features and death factors in Aeromonas septicemia patients with hepatic cirrhosis, and to provide a basis for clinical therapy. Methods The clinical informations, microbial sensitivity and death factors in 29 cases （31 episodes） of Aeromonas septicemia patients with hepatic cirrhosis from September 2001 to September 2008 were conducted through a retrospective survey. Episodes of Aeromonas septicemia patients which occurred at least 2 months apart were counted as separate cases in the analysis. Results There were 31 episodes in 29 cases of Aeromonas septicemia patients with hepatic cirrhosis. 2 cases of patients experienced 2 episodes separately. In 29 patients, there were 27 patients with hepatitis B cirrhosis, among which 2 patients were with primary liver cancer, and the other 2 patients were alcoholic cirrhosis. 32 Aeromonas clinical isolates were seperated from 31 patients, among which 31 Aeromonas hydrophila isolates and 1 Aeromonas sobria isolate were included. The main clinical manifestations were fever （96.8%）, followed by abdominal pain（32.3% ）, nausea and vomiting（32.3% ）, diarrhea（29.0% ）and so on. One case was polymicrobial. 3 cases died within 48 h of septicemia. The mean duration from sampling bled for culture to death was 7.4 days. Septic shock was the only independent prognostic factor for mortality（ RR = 5.2, P 〈 0.01 ）. The resistance of Aeromonas isolates to imipenem and piperacillin-tazobactam was 51.6% and 35.5% respectively. They were universally susceptible to fourth-generation cephalosporins, aminoglycesides and fluoroquinolones. Conclusions In febrile patients with hepatic cirrhosis and suspected Aeromonas infections, it is needed to pay particular attention to the prevention and treatment of septic shock. The antibacterial drugs, such as fourth-generation cephalosperins, aminoglycosides and fluoroquinolones could be the first choice to remedy Aeromonas infections presently.

关 键 词：气单胞菌属 败血症 肝硬化 敏感性 危险因素 

分 类 号：R575.2[医药卫生—消化系统]