肝病患者气单胞菌败血症90例临床特征及转归

The clinical characteristics and outcome of 90 Aeromonas sepsis patients with liver disease

目的加强对气单胞菌败血症的认识,分析90例慢性肝病患者气单胞菌败血症的临床及病原学特点、耐药性及治疗转归。方法查阅2001—2015年住院的肝病患者气单胞菌败血症病例,回顾性分析其临床特征、病原药物敏感性及转归。结果90例气单胞菌败血症中57.78%为院内感染,94.44%患者的基础疾病为肝硬化。临床表现均有发热,50(55.56%)例伴有寒战,高度乏力37(41.11%)例,黄疸加重30(33.33%)例,14(15.56%)例同时存在腹痛及腹泻,13(14.44%)例发生感染性休克。感染菌种以嗜水气单胞菌(47.78%)占优势,16.67%的患者有广谱抗生素应用史,26.67%的患者有抑酸药物应用史。气单胞菌对氨苄西林(96.50%)、头孢唑林(95.60%)、亚胺培南(69.40%)、替卡西林(42.10%)、哌拉西林(34.90%)、复方磺胺甲噁唑(32.70%)和美罗培南(30.60%)的不敏感率较高。按药敏及时抗感染治疗,治愈率和好转率分别为66.67%和21.11%。结论气单胞菌败血症易发生于肝硬化患者,以嗜水气单胞菌为主,有其临床特征及病原学特点,应高度重视,及时针对性抗菌药物治疗。

Objective To strengthen the understanding of Aeromonas septicemia, and analyze the clinical and pathogenic characteristics, drug resistance and treatment outcome of 90 Aeromonas sepsis patients with chronic liver disease. Methods The total of 90 cases of Aeromonas septicemia patients with liver diseases was retrospective analyzed on the clinical features and drug sensitivity and outcome from 2001 to 2015. Results Among 90 cases of Aeromonas septicemia, 57.78% patients were nosocomial infection and 94.44% patients were underlying cirrhosis. The clinical manifestations were fever （100%）, 50 （55.56%） cases with chills, high fatigue in 37 （41.11%） cases, 30 （33.33%） cases with jaundice exacerbation, 14 （15.56%） cases with abdominal pain and diarrhea, 13 （14.44%） cases with septic shock. Aerornonas hydrophila （47.78%） was predominant in the infection pathogens. 16.67% of patients had a history of using broad spectrum antibiotics and 26.67% of patients had a history of using acid suppression. The higher insensitivity of Aeromonas to antibiotics was ampicillin （96.50%）, cefazolin （95.60%）, imipenem （69.40%）,ticarcillin （42.10%）, piperacillin （34.90%）, SMZ-TMP （32.70%） and MEM （30.60%）. The cure rate and improvement rate were 66.67% and 21.11% respectively with targeted therapy according to drug sensitivity. Conclusion .4eromonas septicemia is prone to occur in patients with cirrhosis, mainly with Aeromonas hydrophila. Aeromonas septicemia with its clinical features and pathogenic characteristics should pay high attention and give treatment of targeted antibiotics timely.