肝硬化并发肝衰竭患者血流感染病原菌构成及耐药情况

Pathogenic Bacteria Composition and Drug Resistance of Blood Flow Infection in Patients with Liver Cirrhosis and Liver Failure

目的分析肝硬化并发肝衰竭患者血流感染的病原菌构成情况及其耐药情况,为临床抗菌药物的合理选择和应用提供参考。方法采用回顾性研究方法,选取义马煤业集团股份有限公司总医院2021年1月至2022年6月收治的142例肝硬化合并肝衰竭患者临床资料,均发生血流感染,分析送往检验科进行血液培养的标本,培养细菌并对分离出的菌株进行药敏试验,统计并分析病原菌构成及药敏试验结果。结果142份血液培养标本中共分离出142株致病菌,其中革兰阳性菌46株,占比为32.39%,以金黄色葡萄球菌、凝固酶阴性葡萄球菌为主;革兰阴性菌96株,占比为67.61%,以肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌为主。药敏试验显示,凝固酶阴性葡萄球菌对青霉素、红霉素、头孢西丁的耐药率较高;金黄色葡萄球菌对氨苄西林、青霉素、红霉素的耐药率较高;大肠埃希菌对替考西林、哌拉西林、庆大霉素的耐药率较高;肺炎克雷伯菌对替考西林、哌拉西林、环丙沙星的耐药率较高;铜绿假单胞菌对替考西林、哌拉西林、庆大霉素的耐药率较高。结论肝硬化并发肝衰竭患者血流感染的主要病原菌是革兰阴性菌,不同的病原菌对抗菌药物的耐药性不同,临床需要根据药敏试验结果,合理选择抗菌药物。

Objective To analyze the pathogenic bacteria composition and drug resistance of blood flow infection in patients with liver cirrhosis and liver failure,and to provide reference for rational selection and application of antibacterial drugs in clinical practice.Methods A retrospective study was conducted to select the clinical data of 142 patients with liver cirrhosis and liver failure who were admitted to Yima Coal Group General Hospital from January 2021 to June 2022.All patients had blood flow infection.The samples sent to the laboratory for blood culture were analyzed.The bacteria were cultured by the culture method,and the drug sensitivity test was carried out on the isolated strains.The composition of pathogenic bacteria and the drug sensitivity test results were analyzed.Results A total of 142 pathogenic bacteria were isolated from 142 blood culture samples,of which 46 were Gram positive bacteria,accounting for 32.39%,mainly including Staphylococcus aureus and coagulase negative Staphylococcus.There were 96 strains of Gram negative bacteria,accounting for 67.61%,mainly including Klebsiella pneumoniae,Escherichia coli and Pseudomonas aeruginosa.The drug sensitivity test showed that coagulase negative Staphylococcus had a high resistance rate to penicillin,erythromycin and cefoxitin.Staphylococcus aureus had high resistance rate to ampicillin,penicillin and erythromycin.The resistance rate of Escherichia coli to teicocillin,piperacillin and gentamicin was higher.Klebsiella pneumoniae had a high resistance rate to teicoxicillin,piperacillin and ciprofloxacin.The resistance rate of Pseudomonas aeruginosa to teicoxicillin,piperacillin and gentamicin was high.Conclusion The main pathogenic bacteria of blood flow infection in patients with liver cirrhosis complicated by liver failure is Gram negative bacteria,and different pathogens have different drug resistance to antibiotics.It is necessary to select antibiotics reasonably according to the results of drug sensitivity test in clinical practice.