肝硬化患者气单胞菌败血症50例临床特征及转归

The clinical features and prognosis of Aeromonas septicaemia in hepatic cirrhosis:a report of 50 cases

目的 加强对肝硬化气单胞菌败血症的认识 ,分析肝硬化气单胞菌败血症 5 0例的临床及病原学特点、耐药性及治疗转归。方法 肝硬化患者有感染临床表现者抽取静脉血做培养 ,均用阿克苏公司生产的BacT/Alert12 0血培养系统 ,由法国梅里埃的Vitek AMS6 0全自动细菌鉴定系统鉴定 ,并用纸片扩散法测定对常用抗生素的敏感性。结果 5 0例肝硬化患者气单胞菌败血症 96 %为院内感染 ,夏季多发。菌种以嗜水气单胞菌占优势。多有严重的并发症 ,4 4 %的患者有广谱抗生素应用史 ,4 0 %有长期抑酸药应用史。临床表现为不明原因的发热伴寒战 ,体温上升较快 ,伴有其他症状不同程度的加重 ,如腹痛、腹泻、感染性休克等 ,气单胞菌对第三代头孢菌素、氟喹诺酮类及氨基糖苷类的敏感率均在 80 %以上 ,经第三代头孢菌素或左氧氟沙星及二者联合积极抗感染治疗 ,治愈率分别达 6 4 3%、75 0 %及 5 7 1% ,病死率分别为 2 8 6 %、12 5 %及 35 7%。结论 气单胞菌败血症易发生于重症肝硬化患者 ,来势较凶猛 ,有休克表现者病死率较高 ,应高度重视临床及实验诊断 ,为合理抗菌治疗提供依据。

Objective Aeromonas septicaemia complicating cirrhosis is not a common infectious disease. To enhance the knowledge in this aspect, we analysed the clinical features, pathogenetic factors, resistance, treatment and prognosis of Aeromonas septicaemia in 50 cases of hepatic cirrhosis.Methods We cultured the bacteria from infected patients with BacT/Alert120 automation instrument made in AKsu and identified the bacteria with the Vitek-AMS60 made in Biomerieux company. We then tested the susceptibility of Aeromonas to 13 antimicrobial agents.Results A total of 50 cases of Aeromonas septicaemia occurred in severe hepatic cirrhosis. The majority of them had severe complications. Aeromonas hydrophila was the most common species isolated (52.0%). Nosocomial infection was the predominant way of infection. The major clinical manifestations of Aeromonas septicaemia were fever (100%), chill(64.0%), abdominal pain(60.0%), diarrhoea(32.0%) and shock(24.0%). The susceptive rate of Aeromonas to third generation cephalosporin, quinolones and aminoglycoside antibiotics was more than 80%. The cure rate and mortality attributed to Aeromonas septicaemia after treating with third generation cephalosporin, levofloxacin and their combination were 64.3%,75.0%,57.1% and 28.6%, 12.5%, 35.7% respectively.Conclusion Aeromonas septicaemia tends to befall patients with severe hepatic cirrhosis and causes a rapidly fatal outcome. Aeromonas should be considered an important pathogen for septicemia in patients with liver cirrhosis. It is suggested that we should emphasize the clinical features and laboratory diagnosis so as to have proper antimicrobial treatment.