154例肝硬化失代偿期患者并发血流感染的临床分析

摘要

ObjectiveThe clinical features, bacteria distribution and antibiotic resistance proifle of blood stream infection(BSI) were investigated in the patients with decompensated liver cirrhosis for better management of such infections.MethodsThe clinical data of BSI were collected in the patients with decompensated liver cirrhosis between January, 2012 and December, 2014, and reviewed retrospectively in terms of risk factors, diagnosis and treatment, pathogen distribution and prognosis.ResultsOf the 1 071 patients with decompensated liver cirrhosis and suspected bacterial infection, 154 (14.4%) were diagnosed as BSI evidenced by blood culture. Of these patients, the leukocyte count in the peripheral blood was higher than 10×109/L in only 48 (31.2%) patients; neutrophil proportion>0.75 in 133 patients (86.4%); serum procalcitonin level>0.5 ng/mL in 74 patients (68.5%). A total of 155 bacterial strains were isolated, including 115 strains of gram-negative bacilli and 40 strains of gram-positive cocci. Most patients (68.8%) recovered and 31.2% died or discharged from hospital voluntarily. All these BSI patients had Child-Pugh grade C liver function. Some patients also had other serious systemic diseases or repeated hospitalization.ConclusionThe prevalence of BSI is high in the decompensated liver cirrhosis patients with poor prognosis. Gram-negative bacilli are the major pathogens of such septicemia. Early diagnosis and proper use of antibiotics based on antimicrobial susceptibility testing are important to improve patient outcome.%目的：探讨肝硬化患者并发血流感染（BSI）的临床特点，分析其临床特征、病原菌的分布及耐药特征与患者预后情况，为临床有效诊治并改善临床预后提供依据。方法收集2012年1月至2014年12月住院诊断为肝硬化失代偿期合并BSI患者的临床资料，分析其诱发因素、临床诊断和治疗特点、病原菌分布及临床预后等情况。结果同期收治肝硬化失代偿并行血培养患者1071例，其中血培养阳性患者154例，并发BSI率14.4%。共分离出155株病原菌，分别为革兰阴性菌115株，主要包括大肠埃希菌、肺炎克雷伯菌和气单胞菌属；革兰阳性菌40株主要为金黄色葡萄球菌、缓症链球菌、表皮葡萄球菌。血培养阳性患者中白细胞计数大于10×109/L仅48例（31.2%），中性粒细胞分类大于0.75者133例（86.4%）；降钙素原检测大于0.5 ng/mL 74例（68.5%）；患者治愈好转率为68.8%，死亡及自动出院率为31.2%。并发BSI患者肝功能均为Child-Pugh C级，部分患者合并其他系统疾病或反复多次住院。结论肝硬化失代偿期患者并发BSI的比例高，预后差，病原菌以革兰阴性菌为主。早期诊断并及时予以经验性抗菌治疗，待药敏报告后，根据临床治疗反应，必要时调整抗菌治疗方案，可望改善预后。