肝衰竭患者院内感染的病原学特征及真菌感染相关因素分析  

Analysis of pathogenic characteristics and fungal infection related factors of hospital acquired infections in patients with liver failure

作　　者：黄美雪[1] 吴碧瑜[1] 余雪平[1] 黄奕森[1] HUANG Meixue;WU Biyu;YU Xueping;HUANG Yisen(Quanzhou First Hospital Affiliated to Fujian Medical University,Quanzhou 362000,Fujian,China)

机构地区：[1]福建医科大学附属泉州市第一医院,福建泉州362000

出　　处：《中国病原生物学杂志》2024年第4期482-485,490,共5页Journal of Pathogen Biology

摘　　要：目的探析肝衰竭患者并发院内感染的感染类型、病原菌分布情况、耐药性及真菌感染相关因素。方法选取本院收治的168例肝衰竭并发院内感染患者为本次研究对象,同时选取80例未发生感染者为未感染组。收集患者相关临床资料,分析院内感染类型,并总结归纳肝衰竭患者并发真菌感染的相关影响因素。对疑似院内感染的肝衰竭患者,采集标本进行病原菌培养鉴定及药敏试验。结果168例肝衰竭并发院内感染患者中,主要为腹腔感染(39.88%),其次为呼吸系统感染(30.36%)与消化系统感染(20.24%)。共检出病原菌168株,其中革兰阴性菌占比34.52%,革兰阳性菌占比20.24%,真菌占比45.24%。革兰阴性菌主要为大肠埃希菌、肺炎克雷伯菌,革兰阳性菌主要为溶血葡萄球菌、肺炎链球菌,真菌主要为白色假丝酵母菌、热带假丝酵母菌、烟曲霉。58株革兰阴性菌对庆大霉素、头孢呋辛、左氧氟沙星、环丙沙星的耐药率较高,分别为70.69%、60.34%、58.62%和55.17%,对亚胺培南、美罗培南、阿米卡星的耐药率较低,分别为3.45%、5.17%和1.72%。34株革兰阳性菌对青霉素、红霉素、左氧氟沙星、克林霉素、环丙沙星、四环素的耐药率较高,分别为100%、97.06%、70.59%、61.76%、58.82%和52.94%,未产生对万古霉素、替考拉宁的耐药株。76株真菌对氟康唑、伏立康唑、伊曲康唑的耐药率均较低,分别为19.74%、14.47%和9.21%,未产生对两性霉素B的耐药株。对比真菌感染患者与未感染患者临床资料,年龄、性别、合并高血压、合并肝性脑病差异无统计学意义(P>0.05),合并糖尿病、侵入性操作、合并消化道出血差异有统计学意义(P<0.05)。将上述具有统计学意义的单因素进一步进行二元Logistic分析发现,合并糖尿病、侵入性操作、合并消化道出血是肝衰竭患者合并真菌感染的独立危险因素(P<0.05)。结论肝衰竭合并院内感染患Objective To explore the types of infections,distribution of pathogens,drug resistance,and factors related to fungal infections in patients with liver failure complicated by hospital acquired infections.Methods 168patients with liver failure complicated by hospital acquired infections admitted to our hospital were selected as the study subjects,and 80 patients with liver failure who did not develop hospital acquired infections during the same period of treatment were selected as the uninfected group.The relevant clinical data of patients were collected,the types of hospital infections were analyzed,and the relevant influencing factors of fungal infections in patients with liver failuresummarized.The specimens were collected for pathogen culture,identification and drug sensitivity testing of suspected hospital acquired liver failure patients.Results Among 168patients with liver failure complicated by hospital acquired infections,the main cause was abdominal infection(39.88%),followed by respiratory system infection(30.36%)and digestive system infection(20.24%).A total of 168strains of pathogenic bacteria were detected,of which Gram negative bacteria accounted for 34.52%,Gram positive bacteria accounted for 20.24%,and fungi accounted for 45.24%.Gram negative bacteria were mainly Escherichia coli and Klebsiella pneumoniae,Gram positive bacteria were mainly hemolytic Staphylococcus and Streptococcus pneumoniae,and fungi were mainly Candida albicans,C.tropicalis,and Aspergillus fumigatus.58strains of Gram negative bacteria had high resistance rates to gentamicin,cefuroxime,levofloxacin,and ciprofloxacin,with resistance rates of 70.69%,60.34%,58.62%,and 55.17%,respectively.The resistance rates to imipenem,meropenem,and amikacin were relatively low,with resistance rates of 3.45%,5.17%,and 1.72%,respectively.34Gram positive bacteria showed high resistance rates to penicillin,erythromycin,levofloxacin,clindamycin,ciprofloxacin,and tetracycline,with rates of 100%,97.06%,70.59%,61.76%,58.82%,and 52.94%,respectively.No resis

关 键 词：肝衰竭 院内感染 病原学特征 真菌感染 

分 类 号：R575.3[医药卫生—消化系统] R446.5[医药卫生—内科学]