肝炎肝硬化患者合并败血症病原学及耐药分析

Pathogenic bacteria and antimicrobial resistance of hepatitis cirrhosis patients with septicemia

目的总结肝炎肝硬化患者合并败血症的病原菌分布及耐药情况。方法回顾分析33例肝炎肝硬化合并败血症患者的肝功能指标、凝血指标、外周血象及血培养结果,分析导致败血症的原因。结果 33例患者合并败血症与其肝硬化严重程度相关,致病菌中革兰阳性菌7株(占21.0%),革兰阴性菌26株(占79.0%)。革兰阳性菌株中肺炎链球菌和金黄色葡萄球菌对常用抗菌素普遍耐药,革兰阴性菌株中产酸克雷伯菌耐药率最高,左氧氟沙星对主要革兰阳性菌普遍敏感,哌拉西林/他唑巴坦、头孢替坦对主要革兰阴性菌普遍敏感。结论失代偿期肝硬化患者出现发热寒战首先应考虑败血症可能,致病菌以革兰阴性菌多见,主要为大肠埃希菌。经验性抗菌治疗可首选哌拉西林/他唑巴坦、头孢替坦或左氧氟沙星。

Objective The objective of this study was to study the distribution of pathogens and the development of drug resistance bacteria in chronic hepatitis patients with liver cirrhosis and sepsis. Methods The liver function, coagulation function, peripheral blood and hemocuhure data of 33 hepatitis patients with sepsis and liver cirrhosis were analyzed retrospectively. Results Sepsis of the 33 patients might be related to the severity of the liver cirrhosis. There were seven strains of gram-positive bacterium and 26 strains of gram-negative bacterium, with the 21.0% and 79.0% in the distribution of pathogenic bacteria. Streptococcus pneumoniae and Staphylococcus aureus were generally resistant to the commonly antibiotics among gram-positive. The rate of drug resistance of acid-produced Klebsiella was the highest among Gram-negative germs. Levofloxacin was generally sensitive to gram-positive. Piperacillin/sulbactam and cefotetan were generally sensitive to gram- negative bacterium. Conclusion The first consideration of decompensated cirrhosis patients experienced fever and shivers should be given to the sepsis. Gram-negative bacteria infection was more common, mainly for the escherichia coll. Piperacillin/sulbactam , cefotetan or levofloxacin can be preferred to the empirical antibiotic therapy.