肝硬化失代偿期患者医院感染病原菌的耐药性分析  

Drug resistance of pathogens causing nosocomial infections in patients with decompensated cirrhosis

作　　者：刘东华[1] 胡艳华[2] 王少敏[1] 鲁艳[2] 

机构地区：[1]孝感市中心医院检验科,湖北孝感432000 [2]孝感市中心医院医院感染控制办公室,湖北孝感432000

出　　处：《中华医院感染学杂志》2015年第9期1971-1973,共3页Chinese Journal of Nosocomiology

基　　金：湖北省科技厅自然科学基金项目(2012FFC120)

摘　　要：目的了解肝硬化失代偿期患者并发医院感染的易感部位、病原菌分布及耐药性,为临床预防控制医院感染提供实验室参考指南。方法逐项查阅医院2011年1月-2013年12月肝硬化失代偿期并发医院感染的215例患者临床资料;感染标本的病原菌分离、鉴定均依据临床微生物学检验的常规技术程序进行;药敏检测采用纸片扩散法(K-B法),抑菌圈测量及耐药性判断参照CLSI最新折点;采用WHONET 5.6软件进行数据分析。结果肝硬化失代偿期继发医院感染部位以腹腔、下呼吸道、消化道和泌尿道为主,分别占29.3%、22.2%、15.6%和13.7%;215份感染标本中分离出病原菌288株,其中革兰阴性菌193株占67.0%,革兰阳性菌68株占23.6%,真菌27株占9.4%;病原菌对抗菌药物的多药耐药性和交叉耐药性非常严重,耐甲氧西林金黄色葡萄球菌(MRSA)检出率为45.8%,产超广谱β-内酰胺酶(ESBLs)大肠埃希菌和肺炎克雷伯菌检出率为48.6%;耐亚胺培南铜绿假单胞菌和鲍氏不动杆菌检出率分别为24.4%、27.3%。结论医院感染对肝硬化失代偿期患者生命已构成巨大威胁,临床应减少有创性医疗手段、实施综合性治疗与支持疗法,以提高肝病患者的临床治愈率,延长肝硬化患者的生存期。OBJECTIVE To investigate the susceptible nosocomial infection sites of the patients with decompensated cirrhosis and observe the distribution and drug resistance of the pathogens so as to provide guidance for clinical prevention and control of the nosocomial infections .METHODS The clinical data of 215 decompensated cirrhosis patients complicated with nosocomial infections who were treated in the hospital from Jan 2011 to Dec 2013 were reviewed item by item ,then the isolation and identification of pathogens were carried out by using routine technical procedures of clinical microbiological examination ,the drug susceptibility testing was performed with the use of disk diffusion method （K‐B method） ,the inhibition zones were measured and the drug resistance was interpreted by referring to latest breakpoints of CLSI ,and the data were analyzed by means of WHONET 5 .6 software . RESULTS Among the decompensated cirrhosis patients with secondary nosocomial infections ,29 .3% had the ab‐dominal infection ,22 .2% had the lower respiratory tract infections ,15 .6% had the gastrointestinal tract infec‐tions ,and 13 .7% had the urinary tract infections .A total of 288 strains of pathogens have been isolated from 215 infected specimens ,including 193 （67 .0% ） strains of gram‐negative bacteria ,68 （23 .6% ） strains of gram‐posi‐tive bacteria ,and 27 （9 .4% ） strains of fungi .The pathogens were highly multidrug‐resistant and cross‐resistant to antibiotics .The isolation rate of methicillin‐resistant Staphylococcus aureus （MRSA） was 45 .8% ,the isolation rate of the extended‐spectrum β‐lactamases （ESBLs）‐producing Escherichia coli and K lebsiella pneumoniae was 48 .6% ,and the isolation rates of imipenem‐resistant Pseudomonas aeruginosa and Acinetobacter baumannii were＆amp;nbsp;24 .4% and 27 .3% ,respectively .CONCLUSION The nosocomial infections have threatened the lives of the decom‐pensated cirrhosis patients .It is necessary for the hospital to reduce the invasive me

关 键 词：肝硬化失代偿期 医院感染 病原菌 耐药性 

分 类 号：R378[医药卫生—病原生物学]