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目的分析重症肝病患者医院感染的病原菌分布及耐药性,为临床合理用药提供参考依据。方法回顾性分析2013年1月至2015年10月收治的219例重症肝病患者的临床资料,对患者的标本进行细菌培养、菌株鉴定及药敏试验,分析病原菌分布及常见病原菌的耐药性。结果 219例重症肝病患者中出现医院感染87例,医院感染率为39.73%;共检出病原菌104株,革兰阴性菌56株(53.85%),革兰阳性菌41株(39.42%);标本来源以痰液和腹水为主,分别占37.50%和25.96%;肺炎克雷伯菌、大肠埃希菌对氨苄西林、头孢噻肟、头孢唑林的耐药性较高,对亚胺培南、阿米卡星的耐药性较低;金黄色葡萄球菌、表皮葡萄球菌对青霉素、头孢西丁、哌拉西林、左氧氟沙星、磺胺甲噁唑/甲氧苄啶的耐药率较高,对替考拉宁、万古霉素、阿米卡星的耐药率较低。结论重症肝病医院感染患者病原菌以大肠埃希菌、肺炎克雷伯菌和葡萄球菌属为主,且存在较高的耐药性,在临床治疗中应根据药敏试验结果合理选择抗菌药物。
Objective To analyze the distribution and drug resistance of pathogenic bacteria in nosocomial infections in patients with severe liver diseases and provide reference for clinical rational drug use. Methods The clinical data of 219 patients with severe liver disease admitted from January 2013 to October 2015 were retrospectively analyzed. Bacterial culture, strain identification and drug sensitivity test were performed on the specimens of patients. The distribution of pathogens and drug resistance of common pathogens were analyzed. Results Among the 219 patients with severe liver disease, 87 cases were hospital infection and the hospital infection rate was 39.73%. A total of 104 pathogenic bacteria were detected, including 56 strains (53.85%) of gram-negative bacteria and 41 strains (39.42%) of gram-positive bacteria The sources were sputum and ascites, accounting for 37.50% and 25.96%, respectively. Klebsiella pneumoniae and Escherichia coli were more resistant to ampicillin, cefotaxime and cefazolin, , Amikacin low resistance; Staphylococcus aureus, Staphylococcus epidermidis penicillin, cefoxitin, piperacillin, levofloxacin, sulfamethoxazole / trimethoprim resistance rate is high, the Teicoplanin, vancomycin and amikacin showed low resistance rate. Conclusion The main pathogenic bacteria of hospitalized patients with severe liver disease are Escherichia coli, Klebsiella pneumonia and Staphylococcus, and have high resistance. In clinical treatment, the antibacterial drugs should be selected reasonably according to the results of drug sensitivity test.