1405例肝硬化并发败血症病原特点及预后分析

Pathogenic characteristics and the prognosis in 1405 cirrhotic patients complicated by bacteremia

目的分析肝硬化败血症患者的病原特点及预后,为有效救治提供依据。方法回顾分析我院肝硬化住院患者中有败血症临床征象并血培养阳性的病例资料,进一步分析其感染病原特点及预后。结果 2011—2013年进行血培养的肝硬化患者12 307例,血培养阳性1405例(11.42%)。病原菌包括革兰阴性杆菌(729株,51.89%)、革兰阳性球菌(604株,42.99%)、真菌(51株,3.63%)及其他(21株,1.49%)。败血症组中腹腔穿刺(25.69%)、肝癌有创治疗(18.65%)、静脉留置管(16.65%)、留置导尿管(16.16%)及糖尿病(5.12%)的比例明显高于对照组(P<0.05);革兰阴性杆菌感染组病死率(19.34%)明显高于革兰阳性球菌组(6.46%)(P<0.05);鲍曼不动杆菌感染病死率(56.52%)和铜绿假单胞菌感染病死率(58.62%)明显高于大肠埃希菌(30.23%)(P<0.05)。结论肝硬化败血症以革兰阴性杆菌感染为主,不同种类感染病原的预后不同,穿刺、肝癌有创治疗、插管及糖尿病患者更容易发生败血症。

Objective To analyze the pathogenic characteristics and the prognosis of cirrhotic patients with bacteremia, so as to provide evidence for effective clinical treatment. Methods The clinical data of cirrhotic patients with clinical signs of bacteremia and blood culture positive, who were treated in our hospital during 2011-2013, were analyzed retrospectively. The pathogenic characteristics and prognosis of the patients were analyzed as well. Results Of 12 307 cirrhotic patients undergoing blood culture during 2011-2013, 1405 （11.42%） were blood culture positive. Pathogenic bacteria included 729 （51.89%） strains of gram-negative bacilli, 604 （42.99%） strains of gram-positive cocci, 51 （3.63%） strains of fungi and 21 （1.49%） strains of other bacteria . The proportions of the patients receiving abdominal punctuation （25.69%）, invasive treatment of liver cancer （18.65%）, venous catheter （16.65%） and indwelling urinary catheter （16.16%）, and suffering from diabetes （5.12%） in bacteremia group were significantly higher than those of the control group （P〈0.05）. The mortality rate of gram-negative bacilli group （19.34%） was significantly higher than that of gram-positive cocci group （6.46%） （P〈0.05）. The mortality rates of Acinetobacter baumannii infection （56.52%） and Paeudomomas aeruginosa infection （58.62%） were significantly higher than that of Escherichia coli infection （30.23%） （P〈0.05）. Conclusions Gramnegative bacilli are the most frequent bacteria in cirrhotic patients with bacteremia. The prognosis is different in infections caused by different bacteria. Those patients receiving abdominal punctuation, invasive treatment of liver ca0ncer and venous catheter, and suffering from diabetes are more likely to develop bacteremia.