肝硬化患者合并细菌感染的临床特征分析

Clinical characteristics of bacterial infections in patients with liver cirrhosis

目的探讨肝硬化合并细菌感染住院患者的临床特征.方法回顾性收集2016年1月-2018年12月上海市普陀区中心医院肝硬化住院患者共974例,其中感染病例203例.分析肝硬化患者感染的发生及其细菌分布、医院感染的危险因素以及患者预后.结果该院肝硬化患者细菌感染发生率为20.9%(203/972),以呼吸道感染、腹腔感染、泌尿道感染为主;细菌分布以革兰阴性杆菌为主(57.5%,46/80),多重耐药(MDR)菌比率较高(28.8%,23/80).影响肝硬化患者发生感染的因素包括年龄(OR=1.205)、基础疾病(OR=2.370)、低白蛋白血症(OR=1.730)、侵袭性操作(OR=4.990).非特异性指标C反应蛋白(CRP)、降钙素原(PCT)诊断感染的ROC曲线的曲线下面积分别为0.726和0.740.感染组患者平均住院时间和死亡率高于非感染组(P<0.05).结论肝硬化患者发生感染风险较高,感染仍以革兰阴性杆菌为主,MDR菌比例高,抗感染治疗需考虑经验性MDR覆盖策略;CRP、PCT可作为判断感染的非特异性指标;减少侵袭性操作,补充白蛋白等可降低肝硬化患者感染发生率.

Objective To explore the clinical characteristics of bacterial infections in cirrhotic inpatients.Methods A total of 974 cases of cirrhosis were treated in Shanghai Putuo District Central Hospital from January 2016 through December 2018.Infection was identified in 203 of these patients.The site,pathogens,risk factors,and outcome of infection were analyzed retrospectively.Results The prevalence of bacterial infection was 20.9%(203/972)in cirrhotic patients.The common site of infection was respiratory tract,intra-abdominal,and urinary tract.The major pathogens were gram-negative bacteria(57.5%,46/80).The prevalence of multi-drug resistant(MDR)bacteria was 28.8%(23/80).Multivariate logistic analysis showed that age(OR=1.205),underlying disease(OR=2.370),hypoalbuminemia(OR=1.730),and invasive procedure(OR=4.990)were significant risk factors for hospital infection in cirrhotic patients.The area under the ROC curve of C-reactive protein(CRP)and procalcitonin(PCT)was 0.726 and 0.740,respectively in the diagnosis of infection.The average length of hospital stay of the patients with infection was significantly longer than that of the patients without infection(P<0.05).Infection was associated with significantly higher mortality rate compared to the patients without infection(P<0.05).Conclusions The cirrhotic patients are at high risk of infection,which are primarily caused by gram-negative bacteria.The prevalence of MDR bacteria is high.Empirical MDR coverage strategy should be considered.CRP and PCT can be used as non-specific indicators to diagnose infection.The incidence of infection can be reduced in cirrhotic patients by albumin supplement and avoiding invasive procedures.