预防性抗生素应用对肝硬化并消化道出血患者医院感染的影响

Effect of Antibiotic Prophylaxis on Nosocomial Infection in Cirrhotic Patients with Gastrointestinal Hemorrhage

目的 评估预防性抗生素应用对肝硬化并消化道出血患者医院感染的影响。方法 对 10 2例肝硬化并消化道出血患者随机分为预防性抗生素应用组 (A组 )和对照组 (B组 ) ,A组患者入院后给予抗生素预防性应用 (环丙沙星或哌拉西林 )至出血停止后 3d;B组除常规治疗外 ,未预防性应用抗生素 ;统计两组在医院感染率和死亡率的差异。结果 A组医院感染率为 2 0 .4 % ,B组医院感染率为 5 8.3% ,两组比较差异有显著性 (P<0 .0 0 1) ;医院感染者再出血率为 6 1.5 % ,高于无感染者的 17.5 % (P<0 .0 0 1) ,表明医院感染与再出血率有关 ;A组死亡率为2 0 .4 % ,低于 B组的 4 7.9% (P<0 .0 0 1)。结论 肝硬化并消化道出血患者预防性抗生素应用 ,可降低医院感染发生率和再出血率 ,以提高患者的生存率。

OBJECTIVE To evaluate the effectiveness of a systemic antibiotic prophylaxis in preventing nosocomial infections in cirrhotic patients with gastrointestinal hemorrhage.METHODS A total of 102 cirrhotic patients with gastrointestinal hemorrhage were randomly allocated into two groups. The two groups were comparable regarding age,sex and severity of diseases. Group A included 54 patients,who received antibiotic prophylaxis. This pophylaxis was given from admission to 3 days after cessation of the hemorrhage. Group B included 48 patients,who did not receive antibiotics(controls). The incidence of nosocomial infections and mortality were analysed between the two groups.RESULTS The incidence of nosocomial infections was significantly higher in patients from group B than in patients from group A(58.3% vs 20.4%; P<0.001).The rebleeding was more frequent in patients with bacterial infections(61.5% vs 17.5%; P<0.001).The patients from group B had higher mortality compared with those from group A(47.9% vs 20.4%;P<0.001).CONCLUSIONS In cirrhotic patients with gastrointestinal hemorrhage, a prophylactic treatment with systemic antibiotics is very effective in preventing nosocomial infections.