慢性乙型肝炎患者医院感染的病原学特点及耐药性分析

Etiological characteristics and drug resistance of pathogens causing nosocomial infection in patients with chronic hepatitis B

目的分析慢性乙型肝炎(CHB)患者医院感染的病原菌分布及耐药性,为制订有效的抗感染治疗方案提供研究依据。方法选取2015年4月-2018年5月在福建医科大学附属泉州第一医院住院的81例CHB合并医院感染患者,对其感染情况及病原学特征进行观察和分析。结果CHB合并医院感染患者的主要感染部位为腹腔、下呼吸道、上呼吸道和血液。样本中检出病原菌98株,72株为革兰阴性菌占73.47%,20株为革兰阳性菌占20.41%,6株为真菌占6.12%。主要革兰阴性菌对氨苄西林等具有较强的耐药性,对头孢西丁等较敏感。主要革兰阳性菌对青霉素G等具有较强的耐药性,对哌拉西林/他唑巴坦等较敏感。真菌对氟康唑等具有较强的耐药性,对5-氟胞嘧啶较敏感。结论CHB患者合并医院感染的病原菌以革兰阴性菌为主,这些病原菌具有较高的耐药率,临床医生应密切关注患者的病情进展,根据药敏试验结果选取敏感性抗菌药物进行抗感染治疗。

OBJECTIVE To investigate the distribution and drug resistance of pathogens causing nosocomial infection in the patients with chronic hepatitis B(CHB)so as to put forward effective anti-infection programs.METHODS A total of 81 CHB patients who were complicated with nosocomial infection and treated in Quanzhou First Hospital Affiliated to Fujian Medical University from Apr 2015 to May 2018 were enrolled in the study.The incidence of infection and etiological characteristics were observed.RESULTS The patients with abdominal infection,lower respiratory tract infection,upper respiratory tract infection and blood infection were dominant among the CHB patients complicated with nosocomial infection.Totally 98 strains of pathogens were isolated from specimens,72(73.47%)of which were gram-negative bacteria,20(20.41%)were gram-positive bacteria,and 6(6.12%)were fungi.The major species of gram-negative bacteria were highly resistant to the antibiotics such as ampicillin,while the strains were sensitive to cefoxitin.The major species of gram-positive bacteria were highly resistant to the antibiotics such as penicillin G,while the strains were sensitive to piperacillin-tazobactam.The fungi were highly resistant to the antibiotics such as fluconazole,while the strains were sensitive to 5-fluorocytosine.CONCLUSION The gram-negative bacteria are dominant among the pathogens isolated from the CHB patients complicated with nosocomial infection and are highly drug-resistant.It is necessary for clinicians to pay close attention to the progress of illness and reasonably choose antibiotics for treatment of infection based on the result of drug susceptibility testing.