重症肝病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 severe liver disease

目的探讨重症肝病患者医院感染的多发部位、感染菌种型及耐药特点,为预防控制医院感染提供参考依据。方法选取医院2011年1月-2015年12月重症肝病继发医院感染的247例患者,分析感染患者的病原菌分布及耐药率,数据分析采取WHONET 5.6软件。结果从感染患者标本中分离到308株病原菌,其中革兰阴性菌199株占64.6%;革兰阳性菌77株占25.0%;真菌32株占10.4%;主要革兰阴性菌对磺胺甲噁唑/甲氧苄啶耐药率最高,达到62.2%~69.4%,而耐药率最低的是阿米卡星和头孢哌酮/舒巴坦,为8.2%~22.2%;主要革兰阳性菌对青霉素和氨苄西林耐药率均为100.0%;耐甲氧西林金黄色葡萄球菌(MRSA)检出率为44.4%,产ESBLs菌检出率为47.7%,耐亚胺培南铜绿假单胞菌和鲍氏不动杆菌检出率分别为26.7%、30.6%。结论重症肝病患者医院感染菌的多药耐药性非常严重,临床应合理用药,减少有创性医疗操作,提高重症肝病患者的临床治愈率,延长生存期。

OBJECTIVE To explore the highly prevalent infection sites, distribution and drug resistance of pathogens causing nosocomial infections in patients with severe liver disease so as to provide guidance for prevention and control of the nosocomial infections, METHODS A total of 247 severe liver disease patients with secondary nosoeomial infections who were treated in the hospital from Jan 2011 to Dec 2015 were enrolled in the study. The distribution and drug resistance rates of pathogens causing the infections were observed, and the data were analyzed by using WHONET 5.6 software. RESULTS Totally 308 strains of pathogens were isolated from specimens of the patients with infections, including 199 （64.6%） strains of gram-negative bacteria, 77 （25.0%） strains of gram-positive bacteria, and 32 （10.4 %） strains of fungi. The drug resistance rate of the main gram-negative bacteria to sulfamethoxazole-trimethoprim was the highest, varying from 62. 2% to 69.4%; the drug resistance rates to amikatin and cefoperazone-sulbaetam were the lowest, varying from 8.2% to 22.2%. The drug resistance rates of the main gram-positive bacteria to penicillin and ampicillin were 100. 0%. The isolation rate of methicillin-resistant Staphylococcus aureus （MRSA） was 44. 4%, the isolation rate of ESBLs-producing bacteria was 47.7%; the isolation rates of imipenem-resistant Pseudornonas aeruginosa and Acinetobacter baumannii were 26.7% and 30.6%, respectively. CONCLUSION The pathogens causing the nosocomial infections in the patients with severe liver disease are highly multidrug-resistant. It is necessary for the hospital to reasonably use antibiotics and reduce the invasive medical operations so as to raise the clinical cure rate of the patients with severe liver disease and extend the survival period.