肝硬化患者医院感染病原菌分类及耐药性分析

Investigation of species and drug resistance of pathogens causing nosocomial infections in cirrhotic patients

目的研究入住医院的222例肝硬化患者的医院感染好发部位、病原菌种类及耐药性,为临床用药治疗感染提供参考指南。方法调查统计肝硬化继发医院感染的222例患者临床资料;感染性标本采集、细菌培养与菌种鉴定均严格按照临床微生物学检验的常规程序进行操作;药敏试验采用WHO指定的纸片扩散法(K-B法),抑菌圈直径测量及敏感、中介、耐药数据的读取依据CLSI 2009-2012年新折点分析;药敏数据处理采用WHONET 5.5软件进行。结果 222例肝硬化患者发生医院感染265例次,其感染类型主要为腹腔、下呼吸道、尿路感染,分别占25.2%、20.0%、19.2%;222例肝硬化合并医院感染患者标本中分离出297株病原菌,主要病原菌有大肠埃希菌占22.0%、肺炎克雷伯菌占10.8%、铜绿假单胞菌占14.8%、鲍氏不动杆菌占11.8%、金黄色葡萄球菌占13.8%、粪肠球菌占6.1%等,病原菌多为多药耐药细菌;耐亚胺培南铜绿假单胞菌和鲍氏不动杆菌检出率分别为25.0%、28.6%;产ESBLs细菌检出率为51.9%;耐甲氧西林葡萄球菌(MRS)检出率为60.9%。结论对肝硬化患者应减少有创性医疗操作,实施综合性干预,力图降低医院感染现患率。

OBJECTIVE To investigate predilection sites, pathogenic species and drug resistance ot pathogens causing nosocomial infection in 222 cirrhotic patients and provide the reference and guidance for clinical use of antibiotics for the treatment of infection. METHODS The clinical data were investigated for 222 cases of patients with secondary nosocomial infection of liver cirrhosis. Collection of infective specimen, bacterial culture and species identification were performed strictly as the normal procedures of clinical microbiological tests. The drug susceptibility test was performed by K-B methods recommended by WHO. Diameter measurement of inhibitor zones, read of susceptibility, intermediate and drug resistance data were analyzed according to CLSI 2009-2012 breakpoints. The drug susceptibility data were processed by the WHONET 5.5 software. RESULTS Totally 265 cases of nosocomiaI infections occurred in the patients with liver cirrhosis, of which the main infection were entero-coelia infection, respiratory infection and urinary tract infection, accounting for 25.2%, 20.0%, 19.2%, respec- tively. Totally 297 pathogens were isolated from infective specimens of 222 cirrhotic patients with nosocomial infection. The pathogens mainly included Escherichia coli （22.0 % ）, Klebsiella pneumoniae （10.8 %）, Pseudo-monas aeruginosa （14.8%）, Acinetobacter baumanii （11. 8%）, Staphylococcus aureus （13. 8%）, Enterococcus faecalis （6. 1%） and etc. The pathogens above were mostly multi-drug resistant strains. Detection rates of imipenem resistant P. aeruginosa and A. baurnanii were 25.0 % and 28.6 %, respectively. 51.9 % of strains were ESBLs-produeers. The detection rate of methicillin-resistant Staphylococcus （MRS） was 60.9 %. CONCLUSION The traumatic medical operation should be reduced for cirrhotic patients. We should take a comprehensive intervention to decrease the prevalence rate of nosocomial infection.