严重肝病患者感染病原菌分布及其耐药性研究

目的 研究严重肝病患者感染病原菌的分布特点及其耐药性,为临床疾病的有效预防和感染控制提供理论依据。 方法 选取2013年3月-2015年3月丽水市人民医院肝病病区的326例严重肝病患者为研究对象,对其尿液、血液、腹水等进行采集,分离培养后,对病原菌的分布和耐药性进行研究,菌株鉴定采用法国BioMerieux公司的VITEK32全自动分析仪进行鉴定,药敏实验利用K-B纸片扩散法,结果参考美国临床实验室标准化研究所标准(CLSI)进行判断。数据采用Excel进行统计分析。 结果 从严重肝病患者的送检样品中分离出病原菌1 821株,其中革兰式阴性菌903株,占49.59%;革兰氏阳性菌721株,占39.59%;真菌197株,占10.82%;分离数居前3的病原菌依次为大肠埃希菌(17.63%)、肺炎克雷伯菌(14.33%)和凝固酶阴性葡萄球菌(13.23%)。主要感染部位是腹腔(30.50%)、呼吸道(20.26%)和血液(18.18%),呼吸道感染以白假丝酵母菌最为常见,血液和腹腔感染以大肠埃希菌为主;大肠埃希菌和肺炎克雷伯菌对哌拉西林等药物耐药性较高,但对亚胺培南和美罗培南等抗菌素较为敏感,产超广谱β内酰胺酶大肠埃希菌和肺炎克雷伯菌所占比例分别为37.21%和28.62%。葡萄球菌属对青霉素和红霉素等抗菌药物耐药性较高,但对万古霉素等抗菌药物比较敏感。 结论 严重肝病患者感染病原菌的分布具有独特性,认识主要病原菌对抗菌药的耐受性,可对临床的合理用药提供理论依据。 

Distribution and susceptibility of pathogens isolated from patients with severe liver disease

Objective To investigate the epidemiology of bacterial infections in patients with liver disease and the antimicrobial susceptibility of majority pathogens,and provides theoretical foundation for effective prevention and infection control of the clinical disease. Methods A total of 326 inpatients with liver disease in our hospital were enrolled into this study.The urine,blood and ascites were collected.After isolation and cultivation,the distribution and drug resistance of pathogenics were analyzed.Pathogenics were identified by using VITEK32 automatic bacterial identification system,and the drug susceptibility testing was performed with the use of K-B method.Results referenced to the United States Institute of clinical laboratory standards (CLSI) to determine the standard.Data was analyzed by Excel. Results Total 1 821 strains had been isolated,including 903 Gram-negative strains,accounting for 49.59%,721 Gram-positive strains,accounting for 39.59%,and 151 fungi strains,accounting for 8.29%.The three most common isolates were Escherichia coli (17.63%),Klebsiella pneumonia (14.33%) and coagulase negative Staphylococci (13.23%).The main sites of infection were abdomen (30.5%),respiratory (20.26%) and blood (18.18%).The main causative strain of respiratory infection was Candida albicans.Both Blood infection and peritoneal infection were mainly Escherichia coli.Escherichia coli showed resistant to Piperacillin-tazobactam,but less resistant to Imipenem and Meropenem.The proportion of ESBLS Escherichia coli and Klebsiella pneumonia were 37.21% and 28.62%,respectively.Staphylococcus showed highly resistant to penicillin and erythromycin,but low resistant to vancomycin and teicoplanin. Conclusion The distribution of pathogenic bacteria in patients with severe liver disease is characteristic.The study of distribution and drug resistance of main pathogenics can provide theoretical foundation for the rational use of drugs.