重症肝病患者医院感染病原菌分布及耐药性分析  

Distribution and drug resistance of pathogens causing nosocomial infections in patients with severe liver disease

作　　者：盛棋跃[1] 盛国平[2] 付跃娟[1] 陈海君[1] 范顺富[1] 郭玉香[1] 向晶[1] 

机构地区：[1]金华市中心医院感染科,浙江金华321000 [2]浙江大学医学院附属第一医院感染科,浙江杭州310031

出　　处：《中华医院感染学杂志》2014年第4期828-830,共3页Chinese Journal of Nosocomiology

基　　金：浙江省医学会临床研究基金资助项目(2013ZYC-A119);金华市科技局研究基金资助项目(2012-078-0974X)

摘　　要：目的探讨重症肝病患者医院感染病原菌分布及耐药性,为指导临床合理用药提供理论依据。方法选取医院2010年1月-2013年7月1 477例重症肝病患者,采集患者痰液等标本进行病原菌检测,药物敏感试验采用K-B纸片扩散法。结果 1 477例重症肝病患者中,发生医院感染488例,感染率33.04%;共检出病原菌197株,其中革兰阴性菌116株占58.88%,以大肠埃希菌检出最多,58株占29.44%,其次为肺炎克雷伯菌37株占18.78%;检出革兰阳性菌64株占32.49%,以粪肠球菌检出最多,41株占20.81%;检出真菌17株占8.63%;革兰阴性菌对第三代头孢菌素等抗菌物耐药率较高,部分达100.00%;而耐药率较低的是头孢哌酮/舒巴坦等;革兰阳性球菌对左氧氟沙星等有较高的耐药性,部分达100.00%。结论重症肝病患者治疗中进行病原菌的鉴定和药物敏感性检测,可提高治疗的针对性和有效性,避免盲目用药,减少新耐药株的形成,降低医院感染的发生。OBJECTIVE To explore the distribution and drug resistance of pathogens causing nosocomial infections in patients with severe liver disease so as to provide theoretical basis for reasonable clinical use of antibiotics. METHODS A total of 1477 patients with severe liver disease, who were treated in the hospital from Jan 2010 to Jul 2013, were enrolled in the study, then the sputum specimens were collected for detection of pathogens, and the drug susceptibility testing was performed with the use of K-B method. RESULTS Of the 1477 patients with severe liver disease, the nosocomial infections occurred in 488 cases with the infection rate of 33. 04~. Totally 197 strains of pathogens haven been isolated, including 116 （58.88%） strains of gram-negative bacteria, 64 （32. 490//00） strains of gram-positive bacteria, and 17 （8.63%） strains of fungi~ the Escherichia coli （58 strains ） was the most common species of gram-negative bacteria , accounting for 29.44~, followed by the Klebsiella pneurnoniae （37 strains, 18.78G）; the Enterococcus faecalis was the predominant species of gram-positive bacteria, accounting for 20.81%. The gram-negative bacteria were highly resistant to the third generation cephalosporins, the drug resistance rates of some of the strains were up to 100. 00%, but the drug resistance rates to cefoperazone- sulbactam were low; the gram-positive cocci were highly resistant to levofloxacin, and the drug resistance rates of some of the strains reached up to 100.00 ~. CONCLUSION The effectiveness of targeted treatment of the patients with severe liver disease can be improved through the identification of pathogens and drug susceptibility testing, which may avoid the abuse of antibiotics and reduce the incidence of nosocomial infections.

关 键 词：医院感染 病原菌 耐药性 

分 类 号：R378[医药卫生—病原生物学]