抗菌药物对肝硬化患者感染产超广谱β-内酰胺酶大肠埃希菌的治疗分析

Effect of antibiotic treatment of infections caused by extended-spectrum β-lactamase producing Escherichia coli in patients with cirrhosis

目的分析抗菌药物对肝硬化患者感染产超广谱β-内酰胺酶(ESBLs)大肠埃希菌的疗效。方法选择2006-2013年收治的3 600例肝硬化患者临床资料,对其抗感染治疗疗效进行回顾性分析。结果 3 600例患者发生感染803例,感染率为22.30%,其中产ESBLs大肠埃希菌感染100例,感染率为12.45%;首用喹诺酮类抗菌药物和肝硬化分级ChildpughA在死亡组和生存组感染患者之间差异有统计学意义(P<0.05);在抗感染中,有效与无效的单因素分析显示肝硬化分级Child-pugh C与菌血症差异有统计学意义(P<0.05);而上消化道出血和肝性脑病在生存和死亡组间差异无统计学意义。结论肝硬化患者产ESBLs大肠埃希菌感染使用抗菌药物的疗效较低,其中喹诺酮类药物比三代头孢更适合作为一线用药,抗感染并积极进行保肝治疗,同时及时提供细菌鉴定以及药敏报告,为临床靶向治疗提供重要依据。

OBJECTIVE To investigate the effect of antibiotic treatment in infections caused by extended-spectrum 6- lactamase（ESBL） producing Escherichia coli in patients with cirrhosis. METHODS From 2006 to 2013 the clinical data of cirrhosis patients with infections caused by extended-spectrum β-1actamase（ESBL） producing E. coli were collected, and the effect of antibiotic treatment was analyzed retrospectively. RESULTS Among 3 600 cases, there were 803 cases of infections, with the infection rate of 22. 30%, including 100 cases of infections caused by ESBLs-producing E. coli（12.45%） . There were significantly differences in the first use of quinolone and grading ChildpughA between death group and survival group （P〈0.05） ; in anti-infection, single factor analysis showed that there were significantly differences in Child-pugh C and bacteremia （P 〈 0. 05）; while there were no significant differences in the upper gastrointestinal bleeding and hepatic eneephalopathy between death group and survival group. CONCLUSION The treatment with antibiotic in infections caused by ESBLs-producing E. coli in cirrhotic patients was less effective. Quinolones are more suitable than the third generation cephalosporins as first- line therapy. Anti-infection and hepatoproteetion treatment should be performed, and bacterial identification and susceptibility test results should be provided in time to provide an important basis for clinical targeted therapy.