慢性肝硬化失代偿期患者医院感染病原菌的耐药性分析

Drug resistance of pathogens causing nosocomial infections in patients with chronic decompensated hepatic cirrhosis

目的探讨慢性肝硬化失代偿期患者并发医院感染的临床特点、病原菌种类及耐药性,为合理用药提供参考依据。方法查阅咸宁市两所中医院肝硬化失代偿期并发医院感染的259例住院患者临床资料;病原菌培养与鉴定均严格按照卫生部临床微生物学检验的常规程序操作;药敏试验采用WHO指定的K-B法,抑菌圈直径的敏感、中介、耐药的判断依照CLSI最新折点标准。结果 259例患者发生医院感染347例次,感染部位以腹腔、呼吸道、泌尿道感染为主,分别占23.8%、20.5%、17.0%;共培养出病原菌347株,其中革兰阴性菌234株占67.5%,革兰阳性菌73株占21.0%,真菌40株占11.5%,排名前5位的病原菌依次为大肠埃希菌、铜绿假单胞菌、金黄色葡萄球菌、肺炎克雷伯菌、鲍氏不动杆菌,分别占25.1%、15.6%、13.8%、11.2%、8.9%;革兰阴性菌对亚胺培南、美罗培南耐药率较低,金黄色葡萄球菌对万古霉素、替考拉宁耐药率为0;耐甲氧西林金黄色葡萄球菌检出率达41.7%;产超广谱β-内酰胺酶大肠埃希菌和肺炎克雷伯菌检出率为43.7%;耐亚胺培南铜绿假单胞菌和鲍氏不动杆菌检出率分别为16.7%、22.6%。结论对医院感染有效的干预和控制是成功救治肝硬化失代偿期患者的关键环节,建议临床医师尽量减少和缩短有创性检查和医疗过程,对患者进行综合性治疗,以提高临床治愈率和延长患者的生存期。

OBJECTIVE To explore the clinical characteristics of the chronic decompensated hepatic cirrhosis pa- tients complicated with nosocomial infections, the species of pathogens, and drug resistance so as to provide guid- ance for reasonable use of antibiotics. METHODS The clinical data of 259 patients with chronic decompensated he- patic cirrhosis complicated with nosocomial infections who were hospitalized in two traditional Chinese hospitals in Xianning were reviewed, then the culture and identification of the pathogens were performed by rigidly referring to the conventional operation procedures for clinical microbiological test of the Ministry of Health ; the drug suscepti- bility testing was performed with the use of K-B method specified by WHO; the diameters of inhibitor zones were assessed as the susceptibility, intermediate, and resistance according to the latest breakpoints of CLS1. RESULTS Of totally 259 patients investigated, the nosocomial infections occurred in 347 case-times, among which the pa- tients with abdominal infections accounted for 23.8%, the patients with respiratory tract infections 20.5%, the patients with urinary tract infections 17.0%. A total of 347 strains of pathogens have been isolated, including 234 （67.5%） strains of gram-negative bacteria, 73 （21.0%） strains of gram positive bacteria, and 40 （11.5%） strains of fungi; the Escherichia coli （25.1%）, Pseudornonas aeruginosa （15.6%）, Staphylococcus aureus （13.8%）, Klebsiella pneumoniae （11.2%） and Acinetobacter baumannii （8.9%） ranked the top five si%ecies ofpathogens. The drug resistance rates of the gram-negative bacteria to imipenem and meropenem were relatively low, and the drug resistance rates of the S. aureus to vancomycin and teicoplanin were 0 ; the detection rate of the methicillin-resistant S. aureus was up to 41.7 % the detection rate of the extended-spectrum β-1actamase-producing E. coli or K. pneumoniae was 43.7% ; the detection rates of the imipenem-resistant P. aeruginosa and A. bauman- nii were 16.7 % and 22.6 %, respectively. CONCLUSION The effective intervention and control of nosocomial in- fections is the key to successfully treat the patients with chronic decompensated hepatic cirrhosis; it is suggested that the clinical doctors should try to reduce the invasive examinations and shorten the course of medical procedure and conduct comprehensive treatment so as to improve the clinical cure rate and prolong the patientrs life span.