重型肝炎与肝硬化患者发生院内感染的危险因素及病原菌耐药性分析  

Risk factors and analysis of drug resistance of nosocomial infection in patients with severe hepatitis and cirrhosis

作　　者：刘理冠[1] 徐涛[1] 郑联坵[1] 陈先礼[1] 潘兴南[1] 

机构地区：[1]解放军第一八零医院南京军区肝病中心,福建泉州362000

出　　处：《中国肝脏病杂志（电子版）》2016年第3期64-68,共5页Chinese Journal of Liver Diseases：Electronic Version

基　　金：南京军区医学科技创新课题项目(ZD30)

摘　　要：目的分析重型肝炎与肝硬化患者院内感染的危险因素及病原菌的耐药性,以期为重型肝炎与肝硬化患者住院感染的预防及治疗提供帮助。方法回顾性分析2013年9月至2015年9月本院重型肝炎与肝硬化患者2510例的临床资料,选取发生感染者感染部位的分泌物进行细菌培养。采用法国生物梅里埃全自动微生物系统进行菌种鉴定,药敏试验采用纸片扩散法(K-B法),产ESBLs检测采用双纸片协同试验法。分析患者感染发生率与年龄、住院时间、病程、基础疾病、并发症、侵入性操作和使用抗菌药物间的关系。结果重型肝炎与肝硬化患者2510例中发生感染122例,感染率为4.86%;重型肝炎与肝硬化住院患者感染发生率与年龄、住院时间、病程、基础疾病、并发症、侵入性操作和使用抗菌药物等密切相关,感染部位以呼吸道为主,占27.05%(33/122)。122例送检标本共分离出病原菌139株,其中革兰阴性杆菌95株,占68.35%;革兰阳性球菌30株,占21.58%;真菌14株,占10.07%,以革兰阴性杆菌感染为主。革兰阴性杆菌对亚胺培南、阿米卡星较敏感,对氨苄西林、派拉西林及诺氟沙星有较高的耐药率;克雷伯杆菌对头孢他啶和头孢哌酮也较敏感。革兰阳性球菌对万古霉素均敏感,无耐药菌株出现,对青霉素、氨苄西林、头孢哌酮及红霉素的耐药率均较高。结论患者年龄、住院时间、病程、基础疾病、并发症、侵入性操作及使用抗菌药物等是影响重型肝炎与肝硬化患者医院感染的主要危险因素。病原菌分布广泛,主要以大肠埃希菌、铜绿假单胞菌和克雷伯菌等革兰阴性菌为主;感染部位以呼吸道为主;革兰阴性杆菌对亚胺培南和阿米卡星较敏感,革兰阳性球菌对万古霉素均敏感。Objective To analyze the risk factors and analysis of drug resistance of nosocomial infection in patients with severe hepatitis and cirrhosis. Methods Clinical data of 2510 cases with severe hepatitis and cirrhosis in our hospital from September 2013 to September 2015 were retrospectively analyzed, the bacterial culture of the infection sites was performed. The bacteria were identified by the automated microbiology system bio Merieux, drug susceptibility test was performed by disk diffusion method（K-B method）, ESBLs was detected by double disk synergy test method. The relationship between the incidence of infection and age, length of stay, course of disease, basic diseases, complications, invasive operation and use of antibiotics were analyzed. Results Total of 122 among 2510 cases were infected, the infection rate was 4.86%. The incidence rate was closely related to age, hospital stays, course of disease, underlying diseases, complications, invasive procedures and the use of antibiotics. The infection sites were mainly in respiratory tract and accounting for 27.05%（33/122）. Total of 139 clinical pathogens including 95 Gram-negative bacilli（68.35%）, 30 Grampositive cocci（21.58%） and 14 fungus（10.07%） were isolated from the 122 examined samples. Gramnegative bacilli were sensitive to imipenem and amikacin and had a high rate of resistance to ampicillin, piperacillin faction and norfloxacin. Klebsiella was also sensitive to ceftazidime and cefoperazone. Grampositive cocci was sensitive to vancomycin, non drug resistant strains occured, but it had a high resistance rates to penicillin, ampicillin, cefoperazone and erythromycin. Conclusions Ages, hospital stays, course of disease, underlying diseases, complications, invasive procedures and the use of antibiotics were the mainly risk factors of the nosocomial infection in patients with severe hepatitis and cirrhosis. Clinical pathogens distributed widely, Gram-negative bacteria like Escherichia coli, Pseudomonas aeruginosa, and Klebsiella were main

关 键 词：重型肝炎 肝硬化 院内感染 病原菌 危险因素 耐药性 

分 类 号：R575[医药卫生—消化系统]