摘要
目的研究分析肝硬化失代偿期患者继发医院感染的病原菌类别及耐药特点,为预防控制医院感染提供参考依据。方法查阅肝硬化失代偿期继发医院感染的236例患者病历;感染性标本的采集、细菌培养与鉴定均严格按照临床微生物学检验的常规程序进行操作;药敏试验采用WHO规定的纸片扩散法,抑菌圈直径量取及敏感、中介、耐药数据的判断根据CLSI最新折点标准;检测数据处理采用WHONET 5.5软件。结果 236例患者发生医院感染273例次,主要感染部位是腹腔、呼吸道、尿路、皮肤黏膜及胆道,分别占23.8%、18.7%、17.9%、15.0%、12.1%;共培养出病原菌282株,其中革兰阴性杆菌191株,占67.7%;革兰阳性球菌66株,占23.4%;真菌25株,占8.9%,检出率居前5位的病原菌为大肠埃希菌、金黄色葡萄球菌、铜绿假单胞菌、肺炎克雷伯菌、鲍氏不动杆菌,分别占20.9%、16.3%、14.5%、11.4%、10.3%;革兰阴性菌对常用抗菌药物均产生了一定的耐药性,但对亚胺培南、美罗培南仍保持敏感,革兰阳性球菌中的金黄色葡萄球菌对常用抗菌药物耐药严重,但对万古霉素、替考拉宁100.0%敏感;MRSA检出率为54.3%;耐碳青霉烯类铜绿假单胞菌和鲍氏不动杆菌检出率分别为22.0%、27.6%;产ESBLs大肠埃希菌和肺炎克雷伯菌检出率为48.4%。结论预防控制医院感染是救治肝硬化失代偿期患者的主要环节,应减少有创性医疗,实施综合性干预,以延长肝病患者的生存期。
OBJECTIVE To approach the species of pathogenic bacteria causing secondary nosocomial infections in patients with decompensated cirrhosis and analyze the characteristics of drug resistance so as to provide guidance for the control of nosocomial infections. METHODS The medical records of 236 cases of decompensated cirrhosis patients complicated with secondary nosocomial infections were reviewed, then the collection of infectious specimens and the bacterial culture and identification were performed in strict accordance with the routine procedures of the clinical microorganism laboratory% the drug susceptibility testing was carried out by using the disc diffusion method specified by WHO; the data of the measurement of diameter of inhibition zone, drugs susceptibility, drug intermediary, and drug resistance were interpreted by referring to the latest version of CLSI; the testing data were processed through WHONET 5. 5 software. RESULTS Of totally 236 cases of patients invgstigated, the nosocomial infections occurred in 273 case-times, among which 23. 8% were with abdominal infections, 18.7 % respiratory tract infections, 17.9 % urinary tract infections, 15.0 % mucocutaneous infections, and 12.1% biliary tract infections. A total of 282 strains of pathogens were isolated, including 191 （67.7%） strains of gram-negative bacilli, 66（23.4%） strains of gram-positive cocci, and 25 （8.9%） strains of fungi; the Escherichia coli （20.9%）, Staphylococcus aureus （16. 3%）, Pseudomonas aeruginosa （14. 5%）, K lebsiella pneumoniae （11.4M） and Acinetobacter baumanii （10.3 %） ranked the top 5 species of pathogens isolated. The gram-negative bacteria have produced certain resistance to the commonly used antibiotics but remained susceptibility to imipenem and meropenem; the S. aureus strains were highly resistant to the commonly used antibiotics but were 100.0% susceptible to vancomycin and teicoplanin. The detection rate of MRSA was 54.3% the detection rates of earbapenem-resistant P. aeruginosa and A. baumannii were 22, 0% and 27. 6%, respectively; the detection rates of the ESBLs-producing E. coli and K. pneumoniae were 48.4%. CONCLUSION The control of nosocomial infections is an important link for the treatment of the patients with decompensated cirrhosis, it is necessary to reduce the frequency of traumatic medical operations and implement comprehensive interventions so as to extend the survival time of the patients with liver diseases.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2013年第22期5588-5590,共3页
Chinese Journal of Nosocomiology
基金
湖北省科技厅自然科学基金(2012FFC120)
关键词
肝硬化失代偿期
医院感染
好发部位
致病菌
耐药性
Decompensated cirrhosis
Nosocomial infection
Predilection site
Pathogenic bacteria
Antimicrobial resistance
