肝病患者细菌性血流感染的临床与实验室特点分析

Analysis of clinical and experimental characteristics of bacterial bloodstream infections in patients with liver diseases

目的探讨肝病患者细菌性血流感染的临床及实验特点,为临床早期治疗提供依据。方法回顾性分析2016年1月1日—12月31日期间本院住院肝病患者诊断为血流感染的病历资料,总结患者的临床特征,并比较革兰阴性菌和革兰阳性菌在临床特征、微生物学特征、其他感染指标变化的差异。结果在425例单菌种血流感染病原菌中,院内感染患者309例(72.71%),以革兰阴性菌为主(53.18%)。细菌性血流感染患者主要临床表现包括发热(90.59%)、寒战(40.47%)、感染性休克(17.18%)。革兰阴性菌感染组发热、寒战、休克及腹膜炎的发生率均明显高于革兰阳性菌感染组(P均<0.05)。其他感染指标比较,革兰阴性菌感染组在CRP、降钙素原、WBC及中性粒细胞百分比的升高程度均高于革兰阳性菌感染组(P均<0.05)。革兰阴性菌对抗菌药物的耐药率以氨苄西林最高,为80.50%,其次为复方新诺明(34.47%)和氨苄西林/舒巴坦(33.70%),耐药率较低的包括亚胺培南(3.40%)、美罗培南(2.50%)和阿米卡星(2.00%);革兰阳性菌对抗菌药物的耐药率以红霉素最高,为73.27%,其次为青霉素(65.64%)和苯唑西林(57.00%),对万古霉素、利奈唑胺和替加环素均无耐药菌株。结论细菌性血流感染病原菌以革兰阴性菌为主,其临床表现更严重,辅助感染指标异常变化程度更高。临床应结合血流感染的临床及实验特征,早期经验用药,提高救治率。

Objective To investigate the clinical and experimental characteristics of bacterial bloodstream infections in patients with liver diseases and provide evidence for early clinical treatment.Methods A retrospective analysis was conducted to analyze the medical records of inpatients with the diagnosed bloodstream infection in our hospital from 1 January 2016 to 31 December 2016.The clinical characteristics of infected patients were summarized,and the differences of clinical features,microbiological characteristics and other infectious indicators between gram negative bacteria and gram positive bacteria in infected patients were compared.Results Among 425 cases of single strain bloodstream infections,309(72.71%)cases were diagnosed as nosocomial infection and 53.18%of them were infected with gram negative bacteria.The main clinical manifestations of patients with bacterial bloodstream infections included fever(90.59%),chills(40.47%)and septic shock(17.18%).The incidences of fever,chills,shock and peritonitis in gram negative bacteria group were significantly higher than those in gram positive bacteria group(P<0.05).Compared with other infection indicators,the increments of CRP,procalcitonin,WBC and percentage of neutrophil cells in gram negative bacteria infection group were higher than those in gram positive bacteria infection group(P<0.05).The highest resistance rate to antibiotics in gram negative bacteria was found in ampicillin(80.50%),followed by SMZ-TMP(34.47%)and ampicillin/sulbactam(33.70%).The lower resistance rates to antibiotics were found in imipenem(3.40%),meropenem(2.50%)and amikacin(2.00%).The resistance rate to antibiotics in gram positive bacteria was the highest in erythromycin(73.27%),followed by penicillin(65.64%)and oxacillin(57.00%),and absent in vancomycin,linezolid and tigecycline.Conclusions Gram negative bacteria are the main pathogens of bacterial bloodstream infections with more serious clinical manifestations and higher abnormal levels of auxiliary infection indicators.Patients should be treated by early empirical medication and the survival rate is improved according to clinical and experimental characteristics of bloodstream infections.