肝硬化合并肠杆菌科细菌感染患者临床特点及预后相关因素

Clinical features and prognostic factors of patients with cirrhosis combined with Enterobacteriaceae infection

目的探讨肝硬化合并肠杆菌科细菌感染患者的病原菌分布、临床特点、病死率及其28 d预后相关影响因素。方法回顾性分析2011年1月至2017年1月于浙江大学附属第一医院住院的276例肝硬化合并肠杆菌科细菌感染患者的临床资料,应用多元Logistic回归模型分析感染耐药肠杆菌科细菌的相关危险因素。根据感染28 d预后情况将患者分为存活组和病死组,采用Cox回归分析影响患者28 d预后的相关因素。结果 276例患者共分离出290株肠杆菌科细菌,主要包括大肠埃希菌(35.2%)和肺炎克雷伯菌(44.5%),其中多重耐药菌(MDR)感染占25.5%。多元Logistic分析显示近期使用抗菌药物(OR=2.120,95%CI:1.204~3.731,P=0.009)、上消化道出血(OR=2.864,95%CI:1.209~6.784,P=0.017)是发生耐药菌感染的独立危险因素。Cox回归分析显示CLIF-OF(HR=1.505,95%CI:1.301~1.742,P<0.001)、肾衰竭(HR=1.925,95%CI:1.107~3.347,P=0.020)、脑衰竭(HR=2.431,95%CI:1.248~4.736,P=0.009)和凝血功能衰竭(HR=2.724,95%CI:1.544~4.805,P=0.001)是影响肝硬化合并肠杆菌科细菌感染患者预后的独立危险因素。结论肝硬化合并肠杆菌科细菌感染患者病原菌以大肠埃希菌和肺炎克雷伯菌为主。近期使用抗菌药物和上消化道出血可显著增加肝硬化患者发生多重耐药肠杆菌科细菌感染的风险。高CLIF-OF评分、肾衰竭、脑衰竭和凝血功能衰竭可显著增加患者短期病死率。

Objective To explore the pathogen distribution, clinical characteristics and mortality of cirrhosis patients with Enterobacteriaceae infection(EI), and the relevant risk factors that affect the 28-day prognosis of cirrhosis patients. Methods The clinical data of cirrhosis patients with EI admitted to the hospital from January 2011 to January 2017 were collected. Multiple Logistic regression analysis was performed to analyze the relevant risk factors affecting multidrug resistance of EI. The patients were divided into survival group or non-survival group according to the prognosis of 28 days of infection. Cox regression analysis was used to analyze the relevant factors affecting the 28-day prognosis. Results A total of 290 strains of Enterobacteriaceae bacteria were isolated from 276 patients, among which E. coli and Klebsiella pneumoniae counted for 35.2% and 44.5% respectively. 25.5% of bacterial infections was caused by multidrug resistant bacteria(MDR). Univariate analysis showed that the risk factors for Enterobacteriaceae MDR-infections in cirrhosis patients were recent use of antimicrobials and upper gastrointestinal bleeding. The statistically significant variables of univariate analysis were then analysed in the multivariate logistic regression equation. The results showed that recent use of antibacterial drugs(OR=2.120, 95% CI: 1.204-3.731, P=0.009) and upper gastrointestinal bleeding(OR=2.864, 95% CI: 1.209-6.784, P=0.017) were independent risk factors for drug resistant bacteria infection. The results of Cox regression analysis showed that CLIF-OF(HR=1.505, 95% CI: 1.301-1.742, P<0.001), renal failure(HR=1.925, 95% CI: 1.107-3.347, P=0.020), brain failure(HR=2.431, 95% CI: 1.248-4.736, P=0.009) and coagulation failure(HR=2.724, 95% CI: 1.544-4.805, P=0.001) were independent risk factors affecting prognosis. Conclusion Escherichia coli and Klebsiella pneumoniae are the main pathogens causing cirrhosis complicated by Enterobacteriaceae infection. Recent use of antimicrobials and upper gastrointestinal bleeding can significantly increase the risk of enterobacteriaceae infection in patients with liver cirrhosis, especially multi-drug resistant infections. High CLIF-OF scores, renal failure, brain failure and coagulation failure may significantly increase short-term fatality.