肝病患者合并细菌感染的病原学和耐药特点及抗菌药物选用探讨

Etiology, drug resistance and selection of antibiotics in patients with liver diseases complicated with bacterial infection

目的研究肝病合并细菌感染患者的感染种类和耐药特点,为临床治疗提供参考。方法选取2015年1月至2018年12月在本院就诊的肝病合并细菌感染的患者354例,分析患者感染部位、感染细菌类别以及耐药性。结果细菌感染的主要部位包括呼吸道感染为33.9%,败血症为21.2%,腹腔感染为17.2%,尿路感染为11.9%。共培养细菌403株,其中革兰阴性杆菌占比较高为63.3%;革兰阳性球菌耐药率较低的为万古霉素、替考拉宁、庆大霉素和利福平;大肠埃希氏菌和肺炎克雷伯菌对氨芐西林、哌拉西林、头孢唑林等药物的耐药率高,对亚胺培南、氨曲南等药物敏感度很强。结论肝病患者出现细菌感染最多的部位为呼吸道,其中导致出现感染的病原菌主要为革兰阴性杆菌,对肝病患者进行临床治疗时,需考虑患者感染细菌的部位和细菌类别、耐药性以及药物特点。

Objective To study the types of infection and drug resistance in patients with liver diseases complicated with bacterial infection, to provide reference for clinical treatment. Methods 354 patients with liver disease complicated with bacterial infection were selected from January2015 to December 2018 in our hospital. The infection sites, bacterial types and drug resistance of these patients were analyzed. Results Patients with respiratory tract infection accounted for 33.9%, sepsis for 21.2%, abdominal infection for 17.2% and urinary tract infection for 11.9%, which were the main sites of bacterial infection. 403 strains of bacteria were co-cultured, most of which were Gram-negative bacilli, accounting for 63.3%.The drug resistance rates of gram-positive cocci were lower than vancomycin, tekoranin, gentamicin and rifampicin. Escherichia coli and Klebsiella pneumoniae have high drug resistance rates for drugs such as ambenzyl 6-benzyl, piperacillin and cefazolin, and are highly sensitive to drugs such as imibenzyl and aminotribene. Conclusion Respiratory tract is the most common site of bacterial infection in patients with liver diseases. Gram-negative bacteria is the main pathogens leading to infection. The location and types of bacteria, drug resistance and drug characteristics of patients with liver diseases must be considered in clinical treatment.