肝硬化并产超广谱β内酰胺酶大肠埃希菌感染的抗生素治疗

Antibiotic application in cirrhotic patients with extended-spectrum β-lactamase producing E. coli infection

目的:了解肝硬化患者合并产超广谱内酰胺酶(extended-spectrum beta-lactamase,ESBL)大肠埃希菌感染的抗生素应用情况.方法:收集2006-2011年我院住院肝硬化合并产ESBLs大肠埃希菌感染患者的资料,对患者的基本情况、临床特征、抗感染治疗及疗效进行回顾性分析.结果:4065例次肝硬化住院患者共发生911例次感染,感染部位细菌培养阳性患者455例,其中共有50例肝硬化无重复合并产ESBLs的大肠埃希菌感染患者,有23(46%)例患者首用喹诺酮类(主要为左氧氟沙星),16(32%)例首用三代头孢,11(22%)例首用内酰胺类/内酰胺酶抑制剂(以下简称酶抑制剂),3组患者临床转归未见明显差异(P>0.05).56%的患者换用抗生素.出院时28(56%)例治疗有效,13(26%)例未愈,死亡9(18%)例.感染患者生存组与死亡组相比,肝硬化分级Child-Pugh A(P<0.05)、首用喹诺酮(P<0.05)两者存在显著差异(P<0.05).治疗有效组与无效组相比,菌血症(P<0.05)、肝硬化分级Child-PughC(P<0.05)存在明显差异.肝性脑病、上消化道出血在生存与死亡组差异不明显.结论:肝硬化产ESBLs大肠埃希菌初始经验应用抗生素疗效有效率较低.喹诺酮类较三代头孢更适合第一线用药.抗感染的同时应积极予保肝支持治疗.微生物室应及时提供准确的细菌鉴定和药敏报告,为临床进行靶向治疗提供依据.

AIM：To investigate the antibiotic application in cirrhotic patients with extended-spectrum-lactamase（ESBL）-producing Escherichia coli（E.coli） infection.METHODS：The data for cirrhotic inpatients with ESBL-producing E.coli infection from 2006 to 2011 were collected,and demographic profiles,clinical characteristics,and efficacy of anti-infection treatment were retrospectively analyzed.RESULTS：A total of 911 infections were found among 4065 cirrhotic patients,of whom 455 were culture-positive.Fifty cirrhotic patients had ESBL-producing E.coli infection.Quinolones（mainly levofloxacin） were primarily used in 23（46%） cases,third-generation cephalosporins in 16（32%） cases,and β-lactam/β-lactamase inhibitors in 11（22%） cases.These three groups of patients showed no significant difference in the clinical outcome（P 0.05）.A switch to another antibiotic was found in 28（56%） cases.Twentytwo cases（56%） responded to antibiotic therapy,13 cases（26%） did not respond,and nine cases（18%） died.Compared to the death group,the survival group had significantly different ChildPugh A（P0.05） and initial use of quinolones（P0.05）.Compared to the non-response group,the response group had significantly different Child-Pugh C（P0.05） and bacteremia（P0.05）.Neither hepatic encephalopathy nor upper gastrointestinal hemorrhage differed significantly between the survival and death group.CONCLUSION：The efficacy of initial use of empirical antibiotics is very low in cirrhotic patients with ESBL-producing E.coli infection.Compared to third-generation cephalosporins,quinolones are more effective as the first treatment.Liver function-protecting support therapy should be strengthened when treating such infection.Accurate bacterial identification and antimicrobial susceptibility test should be performed to provide timely targeted therapy.