肝衰竭并感染性休克患者的病原菌谱及耐药性分析

目的分析肝功能衰竭(肝衰竭)并感染性休克患者感染的病原菌分布及耐药情况,为临床治疗提供参考。方法对2005-01—2010-05解放军302医院177例肝衰竭并感染性休克患者感染情况作回顾性统计学分析,病原菌的鉴定及药敏采用法国VITEK-2全自动系统。结果常见感染部位包括腹腔(50.6%)、肺(33.5%)及血液(13.1%)等;病原菌构成比占前3位的分别是大肠埃希菌(37.5%)、肺炎克雷伯菌(11.4%)、金黄色葡萄球菌(8.5%);培养出的革兰阴性菌对多种抗菌药物有不同程度耐药,对亚胺培南、哌拉西林/他唑巴坦及头胞哌酮舒巴坦的耐药率相对较低;大肠埃希菌和肺炎克雷伯菌中产超广谱β-内酰胺酶(ESBLs)比率分别为54.5%和10%;真菌感染最常见病原菌为曲霉菌属,对氟康唑耐药率较高。结论肝衰竭并感染性休克患者感染病原菌常为多药耐药株,病原菌的检测工作对临床治疗有着重要意义。

Distribution and resistance of pathogens isolated from hepatic failure patients with septic shock

Objective To investigate the epidemiology of bacterial infection in patients of hepatic failure associated with septic shock and analyze the antimicrobial susceptibility of their major pathogens.Methods A retrospective survey was conducted in 177 patients of hepatic failure associated with septic shock admitted in the 302nd Hospital of PLA from Jan.2005 to May.2010.Identification and susceptibility of pathogens were determined by VITEK-2 COMPACT System.Results Bacterial infections were identified in abdominal cavity(50.6%),respiratory tract(33.5%) or blood stream(13.1%).The top 3 pathogens were Escherichia coli(37.5%),Klebsiella pneumoniae(11.4%) and Staphylococcus aureus(8.5%).Gram negative bacilli were usually resistant to multiple antibacterial agents,but less resistant to imipenem,piperacillin tazobactam or Cefperazone Sulbactam.Extended spectrum β-lactamases(ESBLs) positive rates of E coli and K pneumoniae were 54.5% and 10%.Aspergillus were the predominant pathogens in fungal infections,and they were mostly resistant to fluconazole.Conclusion Pathogens in patients of hepatic failure associated with septic shock are of mostly multidrug resistance.The microbiological surveillance is important for guiding clinical therapy.