失代偿期肝硬化患者医院获得性肺炎病原菌分布与耐药分析

Pathogenic bacterial distribution and drug resistance analysis of decompensated cirrhosis patients with hospital acquired pneumonia

目的探讨失代偿期肝硬化患者医院获得性肺炎(HAP)的病原学特点,为合理选用抗生素提供依据。方法回顾性分析2012-2016年宁波第四医院发生HAP的失代偿期肝硬化患者感染病原菌情况,并对药敏试验结果进行分析。结果 547例失代偿期肝硬化住院患者中,有93例发生医院获得性肺炎,发生率17.0%;患者送检痰标本中共培养出病原菌120株,其中真菌5株占4.17%,革兰阳性菌32株占26.67%,革兰阴性菌83株占69.17%。检出病原菌中位居前五位的分别为大肠埃希菌、肺炎克雷伯杆菌、鲍曼不动杆菌、阴沟杆菌以及金黄色葡萄球菌。主要病原菌对多数抗菌药物耐药。结论失代偿期肝硬化患者HAP高发,肝肾功能异常导致许多敏感抗菌药物使用受限,需积极治疗基础疾病及并发症,提高机体免疫力,缩短住院时间。

Objective To investigate the etiology of hospital acquired pneumonia（ HAP） in patients with decompensated cirrhosis,and to provide evidence for rational use of antibiotics. Methods From 2012 to 2016,HAP patients with decompensated cirrhosis in Suqian First Hospitals were selected as the research object. The pathogens in patients and the resistance rate were analyzed. Results Among 547 cases of hospitalized patients with decompensated cirrhosis,there were 93 cases of HAP with the incidence rate of 17. 0%. 120 strains of pathogens were isolated,among which 5 strains of fungi accounted for 4. 17%,32 strains of gram positive bacteria accounted for 26. 67%,and 83 strains of gram negative bacteria accounted for 69. 17%. The top five were Escherichia coli,Klebsiella pneumoniae,Bauman Acinetobacter,Enterobacter cloacae and Staphylococcus aureus. These bacteria were resistant to many antibiotics. Conclusion Patients with decompensated liver cirrhosis are prone to HAP. For whom due to abnormal liver and kidney function,the use of antibiotics is limited. It is necessary to actively treat basic diseases and complications,improve immunity and shorten hospital stay.