527例细菌性肝脓肿病原菌分布、耐药性及相关危险因素分析  

Analysis of pathogens distribution, drug resistence and related risk factors in 527 patients with bacterial liver abscess

作　　者：林晓宇[1] 朱月永[1,3] 商红艳[2] 赖瑞敏[1] 张婷[1] 郑琦[1] LIN Xiao-yu;ZHU Yue-yong;SHANG Hong-yan;LAI Rui-min;ZHANG Ting;ZHENG Qi(Department of Hepatology,Hepatology Research Institute,The First Affiliated Hospital,Fujian Medical University,Fuzhou 350005,Fujian Province,China;Department of Laboratory Medicine,Gene Diagnosis Research Center,The First Affiliated Hospital,Fujian Medical University,Fuzhou 350005,Fujian Province,China;Fujian Key Laboratory of Precision Medicine for Cancer,The First Affiliated Hospital,Fujian Medical University,Fuzhou 350005,Fujian Province,China)

机构地区：[1]福建医科大学附属第一医院肝病中心肝病研究所,福建福州350005 [2]福建医科大学附属第一医院检验科基因诊断研究中心,福建福州350005 [3]福建医科大学附属第一医院福建省肿瘤精准诊疗重点实验室,福建福州350005

出　　处：《中国临床药理学杂志》2021年第7期873-877,共5页The Chinese Journal of Clinical Pharmacology

基　　金：福建省科技厅社会发展引导性(重点)基金资助项目(2019Y0014);福建医科大学启航基金资助项目(2018QH1052)。

摘　　要：目的分析细菌性肝脓肿的病原菌分布、耐药特征及影响常见细菌感染危险因素。方法回顾性分析2014年至2018年我院肝病中心就诊的肝脓肿患者的病原学及临床资料,用卡方检验及Logistic回归分析感染的相关危险因素。结果细菌性肝脓肿病原菌以革兰氏阴性菌多见,占84.10%,其中肺炎克雷伯菌占59.32%,大肠埃希菌占14.67%,铜绿假单胞菌占4.28%,革兰氏阳性菌占15.90%。肺炎克雷伯菌对哌拉西林/他唑巴坦、阿米卡星、喹诺酮类、第3代头孢、头孢替坦均有较好的敏感性。31.25%大肠埃希菌产超广谱β内酰胺酶,对哌拉西林/他唑巴坦、阿米卡星、头孢替坦敏感性均较好,头孢曲松耐药率高达54.17%。铜绿假单胞菌对碳青霉烯类药物耐药率达42.86%。除鹑鸡肠球菌和铅黄肠球菌外,各类肠球菌及金黄色葡萄球菌对万古霉素、利奈唑胺及替加环素均敏感。糖尿病患者肺炎克雷伯菌感染多见,胆石症、胃肠道手术史是其他病原学肝脓肿高危因素(均P<0.05)。结论细菌性肝脓肿病原培养菌种多样化,致病菌以革兰氏阴性菌为主,最常见为肺炎克雷伯菌、大肠埃希菌,应结合患者基础病、病原学和药敏特点合理使用抗生素。Objective To review the bacterial spectrum,drug resistance characteristics and related risk factors with bacterial liver abscess.Methods A retrospective analysis was conducted with the microbiological and clinical date of 527 patients with bacterial liver abscess.The patients were treated in the liver research center of the First Affiliated Hospital of Fujian Medical University from January 2014 to December 2018.Chi-square test and Logistic regression analysis were used to analyze the risk factors of non-Klebsiella pneumonia infection.Results Gram-negative bacteria were the most common pathogens of bacterial liver abscess,accounting for 84.10%,of which Klebsiella pneumoniae,Escherichia coli,and Pseudomonas aeruginosa account for 59.32%,14.67%and 4.28%,respectively.Gram positive Bacteria accounted for 15.90%.Klebsiella pneumoniae has good sensitivity to piperacillin tazobactam,amikacin,quinolones,third-generation cephalosporins,and cefotetan.31.25%of Escherichia coli produces extended-spectrumβ-lactamase,and they have good sensitivity to piperacillin tazobactam,amikacin,cefotetan,but the resistance rate of ceftriaxone reaches 54.17%.The resistance rate of Pseudomonas aeruginosa to carbapenems reached 42.86%.In addition to Enterococcus gallinarum and Enterococcus casseliflavus,various types of Enterococci and Staphylococcus aureus are sensitive to vancomycin,linezolid and tigecycline.Klebsiella pneumoniae infections are common in diabetic patients.Cholelithiasis and history of gastrointestinal surgery are high-risk factors for infecting other pathogens(all P<0.05).Conclusion This study suggest that the pathogens of bacterial liver abscess is diversified,Gram-negative bacteria is the predominant pathogen of bacterial liver abscess.The most common pathogens are Klebsiella pneumoniae and Escherichia coli,appropriate antibiotics should be selected according to patient’s basic disease,pathogen and drug sensitivity features.

关 键 词：细菌性肝脓肿 病原学 药敏 肺炎克雷伯菌 大肠埃希菌 

分 类 号：R978.1[医药卫生—药品]