重症肝病患者医院感染病原菌分布及耐药性研究

摘要

目的 了解重症肝病患者医院感染病原菌分布特点及耐药情况,为临床治疗提供参考.方法 对2008年1月至2012年6月本院收治的486例住院肝病患者腹水、血液、痰液及尿液等标本分离培养出的病原菌的分布及耐药情况进行统计分析.结果 重症肝病患者医院感染率24.9％(121/486),121例患者共分离出158株病原菌,其中革兰阴性杆菌108株(68.4％),革兰阳性球菌37株(23.4％),真菌13株(8.2％).分离率前3位的病原菌依次为大肠埃希菌、凝固酶阴性葡萄球菌、肺炎克雷伯菌.大肠埃希菌对氨苄西林、头孢曲松等多种抗菌药物耐药率较高,但对亚胺培南、阿米卡星及头孢哌酮/舒巴坦仍高度敏感,产超广谱β内酰胺酶(ESBLs)大肠埃希菌占14.3％.葡萄球菌对青霉素和红霉素耐药率较高,但对万古霉素和替考拉宁全部敏感.结论重症肝病患者医院感染发生率较高,大肠埃希菌及葡萄球菌为感染主要病原菌,且耐药率较高.%Objective To investigate the distribution and resistance of nosocomial infection pathogens in patients with severe hepatopathy.Methods All the pathogenic bacteria isolated from clinical specimens of 486 hospitalized patients with severe hepatopathy from January 2008 to June 2012 were retrospectively analyzed.Results The incidence rate of nosocomial infection in severe hepatopathy patients was 24.9 ％ (121/486).158 strains of pathogens were isolated from 121 patients,among which 108 strains(68.4 ％) were gram-negative bacilli,37strains (23.4 ％) were gram-positive cocci,and 13 strains(8.2 ％) were fungi.Escherichia coli,coagulase negative Staphylococci and Klebsiella pneumonia were the three most common isolates.The resistance rates of Escherichia coli to ampicillin,ceftriaxone,ciprofloxacin,and cotrimoxazole were high,ranged from 44.6 ％ to 76.8 ％,but to Imipenem,amikacin,and Cefperazone-Sulbactam were lower,ranged from 0 ％ to 8.9 ％.14.3 ％ of Escherichia coli were extended-spectrum β-lactamase producing strains.The resistance rates of Staphylococcus to Penicillin and Erythromycin were higher,ranged from 66.7％ to 95.5 ％,while to Vancomycin and teicoplanin were low to 0 ％.Conclusion The incidence rate of nosocomial infection in severe hepatopathy is high.Escherichia coli and Staphylococci are the most prevalent strains,and had a higher resistance to common antibiotics.