重症肝病患者病原菌感染分布及耐药性分析

摘要

目的 探讨重症肝病患者病原菌感染的分布及耐药性,为临床抗感染经验性用药提供依据.方法 回顾性分析2014年8月-2016年11月于我院感染科病房住院的重症肝病患者的微生物标本.微生物检验为常规方法培养、分离、鉴定病原菌,药敏试验采用K-B法.结果 73例重症肝病患者中,发生医院感染17例,感染率23.3％.共分离出104株病原菌,其中多重耐药菌78株(75.0％).104株病原菌中革兰阳性球菌28株(26.9％),以肠球菌、金黄色葡萄球菌为主;革兰阴性杆菌58株(55.8％),以大肠埃希菌、鲍曼不动杆菌及肺炎克雷伯杆菌为主;真菌18株(17.3％).金黄色葡萄球菌和肠球菌对青霉素、红霉素、左旋氧氟沙星的耐药率均＞80.0％,对万古霉素、替考拉宁、替加环素的耐药率较低;大肠埃希菌和肺炎克雷伯菌对哌拉西林、头孢唑啉、头孢呋辛钠的耐药率＞85.0％,对替加环素及阿米卡星耐药率较低;鲍曼不动杆菌对哌拉西林/他唑巴坦、头孢他啶、亚胺培南及阿米卡星的耐药率高达100％,对替加环素及米诺环素耐药率较低.结论 重症肝病患者感染的病原菌大多数为多重耐药菌,对常用抗菌药耐药率较高,经验性治疗需要使用广谱抗生素或高级别抗生素(如碳青霉烯类或替加环素),以及针对特定病原菌的药物(糖肽类、利奈唑胺、阿米卡星等);在肝硬化患者的治疗中,建议早期降阶梯治疗以防止多重耐药菌的传播.%Objective To explore the infection distribution and drug resistance of pathogens in patients with severe liver disease,and provide reference for clinical medication.Methods Retrospective analysis of the microbiological specimens from patients with severe liver disease in Department of Infection of our hospital from August 2014 to November 2016 and the drug susceptibility testing were carried out by means of K-B disc diffusion method after bacterial culturing,and the distribution and drug resistance of pathogens were analyzed.Results Totally 17 of 73 patients with severe liver disease developed hospital infection (23.3％).104 strains of bacteria were isolated and 78 strains out of them were multidrug-resistant bacteria (75.0％).Among them,28(26.9％) strains were gram-positive coccus,mainly consisting of Staphylococcus aureus and Staphylococcus epidermidis,and 58(55.8％) were gram-negative coccus,mainly composed of Escherichia coli,Klebsiella pneumonia and Acinetobacter baumannii,and 18(17.3％) strains fungi.S.aureus and enterococci were resistant to penicillin,erythromycin and levofloxacin,the resistance rates were above 80.0％,but had low resistance rates to vancomycin,teicoplanin and tigecycline.The resistance rates of E.coli and K.pneumoniae to piperacillin,cefazolin and cefuroxime sodium were above 85.0％,but they had lower resistance rates to tigecycline and amikacin.Acinetobacter baumannii was 100％ resistant to piperacillin and tazobactam,ceftazidime,imipenem and amikacin,but had low resistance to tigecycline and minocycline.Conclusions Multi-drug resistant bacteria are the main bacterial pathogens in patients with severe liver disease and have a high resistance rate to commonly used antibiotics,empirical treatment in the population at high risk of multidrug-resistant bacteria infections requires the use of broad-spectrum or high-grade antibiotics (e.g.carbapenems or tigecycline) and drugs against specific pathogenic bacteria (glycopeptides,linezolid,and amikacin etc).Early de-escalation policies are recommended to prevent the spread of multidrug-resistant bacteria in cirrhosis.