肝病并感染性休克患者感染病原菌的分布及耐药性分析

Distribution and Susceptibility of Pathogens Isolated from Liver Disease Patients with Septic Shock

目的分析肝病并感染性休克患者合并感染的病原菌分布及耐药情况,为临床治疗提供参考。方法对2005年1月-2008年8月医院83例肝病并感染性休克患者感染情况作回顾性分析,病原菌的鉴定及药敏采用MicroScanAuto-4全自动系统。结果常见感染部位包括腹腔(73.5%)、血液(24.1%)及呼吸道(13.3%)等;分离数居前3位的病原菌是大肠埃希菌(36.6%)、肺炎克雷伯菌(15.9%)、金黄色葡萄球菌(6.1%);分离到的革兰阴性菌对多种抗菌药物有不同程度耐药,对亚胺培南、左氧氟沙星及哌拉西林/他唑巴坦耐药率相对较低;大肠埃希菌和肺炎克雷伯菌中产超广谱β-内酰胺酶(ESBLs)比率分别为53.3%和7.7%;真菌感染最常见病原菌为曲霉菌属及光滑假丝酵母菌,对氟康唑耐药率较高。结论肝病并感染性休克患者感染病原菌常为多药耐药株,病原菌的监测工作对临床治疗有着重要意义。

OBJECTIVE To investigate the epidemiology of bacterial infections isolated from liver disease patients with septic shock and analyze the antimierobial susceptibility of major pathogens to provide reference for clinical therapy. METHODS A retrospective survey was conducted in 83 liver disease patients with septic shock of our hospital from Jan 2005 to Aug 2006. Identification and susceptibility of pathogens were assayed by MicroScan Auto-4 System. RESULTS The infection was frequently identified in intra-abdominal cavity （73. 5%）, blood stream （24.1%） or respiratory tract （13.3%）. The top 3 pathogens were Escherichia coli （36.6%）, Klebsiella pneumoniae （15. 9%） and Staphylococcus aureus （6. 1%）. Gram-negative bacilli were usually resistant to multiple antimicrobial agents, but less resistant to imipenem, levofloxacin or piperacillin-tazobactam. Extended- spectrum β-lactamases （ESBLs） positive rates of E. coli and K. pneumoniae were 53.3 % and 7.7 %. Asprergillus and Candida glabrata were the predominant pathogens from fungal infections,and they were mostly resistant to flueonazole. CONCLUSIONS Pathogens of liver disease patients with septic shock are mostly multi-drug resistant. The microbiological surveillance is important for guiding clinical therapy.