重症肝炎患者人工肝术后并发医院感染的调查分析

Analysis on pathogen of severe hepatitis complicating nosocomial infection after artificial liver system treatment

目的分析重症肝炎患者人工肝术后并发感染的病原菌分布及耐药情况。方法回顾性调查88例重症肝炎患者人工肝术后并发感染的临床资料，对感染病原菌的分布及耐药率进行统计分析。结果重症肝炎患者人工肝术后感染发生率为30．34％。88例患者感染的主要部位为：肺部（27．03％）、口腔（22．30％）、肠道（19．59％）、胆道（15．54％）。2种以上细菌混合感染患者占54．67％。在分离的病原菌株中，真菌比例最高，占55．24％，其中白色念珠菌占19．58％，热带念珠菌占14．69％。革兰氏阳性菌占23．78％，肠球菌占9．09％，葡萄球菌5．59％，链球菌4．20％；革兰氏阴性菌占20．98％，肺炎克雷伯氏菌占8．39％，大肠埃希氏菌占4．90％。真菌对二性霉素B最敏感，其次为氟康唑；革兰氏阳性菌对万古霉素、替考拉宁最敏感；革兰氏阴性菌对亚胺培南、阿米卡星敏感。结论重症肝炎患者人工肝术后感染发生率高，多部位及细菌混合感染多见。所分离的病原菌中，真菌比例最高，病原菌对临床上常用抗生素有较高的耐药性。为降低人工肝术后感染的发生率，应尽量减少和避免诱发感染的危险因素，采取综合防治措施。

Objective To investigate the distribution of pathogen and drug resistance in the patients with serious hepatitis complicating nosocomial infection after artificial liver system treatment. Methods The clinical data of 88 cases of severe hepatitis complicating nosocomial infection after artificial liver system treatment were investigated and analyzed retrospectively. Results Infection occurred in 30.34% patients after artificial liver system treatment, the major infectious parts of 88 cases were lung（27.03%）, oral cavity （22.30%）, intestines tract（19.59%）, biliary tract（15.54%）. Mixed infections of over two strains of bacteria were 54.67%. Fungus occupied 55.24% in the separated bacterial strains（Candida alhieans 19.58%, Albicans tropicals 14.69%）; Grampositive bacteria occupied 23.78%（Enteroeoeei9.09%, Staphylococci 5.59%, Streptococci4.20%）; Gram-negative bacteria occupied 20.98%（Klebsiella pneumoniae 8,39%, Escherichia coli4.90%）.Funguses were most sensitive to Amphomoronal B, Fluconazole secondly. Gram-positive bacteria were sensitive to Vancomycin and Teieoplanin, Gram-negative bacteria were sensitive to Imipenem and Amikacin. Conclusion The incidence rate of infection is high in the patients with severe hepatitis after artifical liver system treatment. Fungus occupy the major part of the separated pathogen, most pathogens are resisted to common antibacterial agent. Comprehensive measures must be taken to prevent and avoid the risk of infection.