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目的探讨慢性肝硬化失代偿期患者并发医院感染的临床特点、病原菌种类及耐药性,为合理用药提供参考依据。方法查阅咸宁市两所中医院肝硬化失代偿期并发医院感染的259例住院患者临床资料;病原菌培养与鉴定均严格按照卫生部临床微生物学检验的常规程序操作;药敏试验采用WHO指定的K-B法,抑菌圈直径的敏感、中介、耐药的判断依照CLSI最新折点标准。结果 259例患者发生医院感染347例次,感染部位以腹腔、呼吸道、泌尿道感染为主,分别占23.8%、20.5%、17.0%;共培养出病原菌347株,其中革兰阴性菌234株占67.5%,革兰阳性菌73株占21.0%,真菌40株占11.5%,排名前5位的病原菌依次为大肠埃希菌、铜绿假单胞菌、金黄色葡萄球菌、肺炎克雷伯菌、鲍氏不动杆菌,分别占25.1%、15.6%、13.8%、11.2%、8.9%;革兰阴性菌对亚胺培南、美罗培南耐药率较低,金黄色葡萄球菌对万古霉素、替考拉宁耐药率为0;耐甲氧西林金黄色葡萄球菌检出率达41.7%;产超广谱β-内酰胺酶大肠埃希菌和肺炎克雷伯菌检出率为43.7%;耐亚胺培南铜绿假单胞菌和鲍氏不动杆菌检出率分别为16.7%、22.6%。结论对医院感染有效的干预和控制是成功救治肝硬化失代偿期患者的关键环节,建议临床医师尽量减少和缩短有创性检查和医疗过程,对患者进行综合性治疗,以提高临床治愈率和延长患者的生存期。
Objective To investigate the clinical features, pathogens and drug resistance of nosocomial infections in patients with decompensated chronic liver cirrhosis and to provide a reference for rational drug use. Methods The clinical data of 259 hospitalized patients with decompensated liver cirrhosis from two hospitals of Xianning were enrolled in this study. The pathogen culture and identification were all conducted in accordance with the routine procedures of clinical microbiology test of Ministry of Health. KB method, bacteriostatic circle diameter sensitive, intermediary, resistance to judge in accordance with the CLSI latest discount standards. Results A total of 347 cases of nosocomial infections occurred in 259 patients. The infection sites were mainly abdominal cavity, respiratory tract and urinary tract infections, accounting for 23.8%, 20.5% and 17.0% respectively. There were 347 co-cultivated pathogens, of which 234 were Gram-negative bacteria 67.5%, 73 strains of Gram-positive bacteria accounted for 21.0% and 40 strains of fungi accounted for 11.5%. The top 5 pathogens were Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii accounted for 25.1%, 15.6%, 13.8%, 11.2% and 8.9% respectively. The resistance rate of gram negative bacteria to imipenem and meropenem was low. Staphylococcus aureus was resistant to vancomycin, The rate of teicoplanin resistance was 0; methicillin-resistant Staphylococcus aureus was detected in 41.7%; the detection rate of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae was 43.7% ; Imipenem-resistant Pseudomonas aeruginosa and Acinetobacter baumannii detection rates were 16.7%, 22.6%. Conclusion The effective intervention and control of nosocomial infection is the key to successful treatment of patients with decompensated cirrhosis. It is suggested that clinicians try their best to reduce and shorten the procedure of invasive examination and medical treatment and to comprehensively treat patients so as to improve the clinical cure rate And prolong patient’s life span.