肝病患者细菌感染的类型及耐药性

The distribution and resistance of Gram-negative bacteria in liver diseases

目的 了解肝病患者的革兰氏阴性细菌感染的类型及耐药性 ,为临床合理用药提供依据。方法 分析 2 0 0 0～ 2 0 0 2年传染病医院肝病患者的革兰氏阴性细菌感染的类型、分布及耐药情况 ,并加以分析比较。结果 从 5 39例患者分离到 6 5 5株革兰氏阴性菌 ,分别来源于血液 16 9,腹水 174 ,痰及咽拭子 178,尿液134。菌属分布包括大肠埃希氏菌 4 4 .89% ,克雷伯氏菌属 18.17% ,气单胞菌属 13.13% ,不动杆菌属 7.0 2 % ,假单胞菌属 5 .95 % ,肠杆菌属 5 .34%。气单胞菌属主要在血液、腹水中占 94 .19% ,不动杆菌属、铜绿假单胞菌主要在呼吸道占 73.91%和 74 .36 % ,而尿道感染大肠埃希氏菌占绝对优势 ,70 .90 %。不同菌属对不同种类抗生素的敏感性不同。产 ESBL s菌分布于大肠埃希氏菌及肺炎克雷伯氏菌 ,产酶率分别为 18.0 3%及2 1.0 1%。对抗生素的敏感率在 ESBL阴性组以亚胺培南 /西司他丁、头孢哌酮 /舒巴坦、第三代头孢菌素和阿米卡星较好。产酶菌对亚胺培南 /西司他丁和头孢美唑的敏感性较好。结论 肝病患者革兰氏阴性细菌感染的感染部位、菌属分布及耐药性有其自身的特点。临床用药应根据感染部位、菌属及药敏结果综合分析 ,真正做到合理用药。

Objective To investigate the distribution and resistance of bacteria causing liver diseases. Methods Six hundrud fifty five Gram-negative strains were isolated from 539 liver disease patients in our hospital. Bacteria were cultured with blood disc and identified with the Vitek-AMS60. Susceptibility of bacteria to antibiotics were determined by K-B methods. Results All Gram-negative isolates consist of Escherichia coli 44.89%, Klebsiella genus 18.17%. Aeromonas genus 13.13%, Acinetobacter spp. 7.02%, Pseudomonas spp. 5.95% and Enterbacter genus 5.34%. Different bacteria had dissimilar susceptibility to different antibiotic. The incidence of ESBLs in Escherichia coli and Klebsiella pneumoniae was 18.03% and 21.01% respectively. The susceptibility of imipenem/cilastain,cefoperazone/sulbactam,third generation cephalosporin( and amikacin was good for non-ESBLs isolates and the susceptibility of imipenem/cilastain and cefmetazole was good for ESBLs isolates. Conclusion In order to rationalize the treatment approaches of the liver disease patients affected with Gram negative bacteria, a composite consideration of various cause, e.g. infection site, distribution of different genera of the organisms and their resistance which had their own characteristics, should be carefully considered.