Tu B, Liu S X, Wu D, Zhang X, Shi L, Xie Y X, Zhao P, Qin E Q
302 Hospital of PLA, Beijing 100039, China.
Zhonghua Gan Zang Bing Za Zhi. 2018 Jan 20;26(1):23-27. doi: 10.3760/cma.j.issn.1007-3418.2018.01.007.
o investigate the features of pathogenic bacteria for community-acquired bloodstream infection due to Gram-negative bacilli in patients with liver cirrhosis and optimal therapeutic strategy. A retrospective analysis was performed for the clinical data of patients with liver cirrhosis who were admitted to 302 Hospital of PLA due to community-acquired bloodstream infection from January 2010 to December 2015, and a statistical analysis was performed for their clinical features, pathogenic bacteria, and results of drug sensitivity test. The Pearson chi-square test was used for comparison of rates, and the Wilcoxon rank sum test was used for comparison of ranked data. A total of 240 patients (including 178 male patients) with liver cirrhosis caused by various reasons were enrolled, with a mean age of 51.7 ± 11.1 years, an overall clinical remission rate of 80.42%, and an ineffective/mortality rate of 19.58%. The patients who used sensitive antibiotics within 12 hours after the onset of community-acquired bloodstream infection achieved a significantly higher improvement rate than those who used such drugs at more than 12 hours after onset (88.2% vs 58.1%, < 0.001). The improvement rate achieved by the application of sensitive antibiotics at more than 12 hours after onset decreased with the increase in the Child-Pugh grade ( < 0.05). A total of 245 strains of Gram-negative bacilli were isolated, among which the six most common ones were 135 strains of Escherichia coli (55.1%), 62 strains of Klebsiella pneumoniae (25.3%), 16 strains of Aeromonas (6.5%), 4 strains of non-typhoidal Salmonella (1.6%), 3 strains of Enterobacter cloacae (1.2%), and 2 strains of Acinetobacter baumannii (0.8%). These Gram-negative bacilli had the highest sensitivity to meropenem (98.5%), followed by imipenem (97.9%), amikacin (97.5%), piperacillin/tazobactam (94.7%), cefmetazole (93.7%), and cefoperazone/sulbactam (93%). Different bacteria had different sensitivities to antibiotics. Once community-acquired bloodstream infection occurs in patients with liver cirrhosis, highly sensitive antibiotics should be used as early as possible. Cefoperazone/sulbactam, piperacillin/tazobactam, imipenem, and meropenem can be used as first-line empirical antibiotics, and drug combination should be considered when necessary.
探讨肝硬化患者社区获得性血流感染革兰阴性杆菌的病原菌特点及最佳治疗策略。对2010年1月至2015年12月因社区获得性血流感染入住解放军第302医院的肝硬化患者临床资料进行回顾性分析，并对其临床特征、病原菌及药敏试验结果进行统计分析。率的比较采用Pearson卡方检验，等级资料的比较采用Wilcoxon秩和检验。共纳入240例因各种原因导致肝硬化的患者（其中男性178例），平均年龄51.7±11.1岁，总体临床缓解率为80.42%，无效/死亡率为19.58%。社区获得性血流感染发病后12小时内使用敏感抗生素的患者改善率显著高于发病后12小时以上使用此类药物的患者（88.2%比58.1%，P<0.001）。发病后12小时以上应用敏感抗生素的改善率随Child-Pugh分级升高而降低（P<0.05）。共分离出245株革兰阴性杆菌，其中最常见的6种分别为大肠埃希菌135株（55.1%）、肺炎克雷伯菌62株（25.3%）、气单胞菌16株（6.5%）、非伤寒沙门菌4株（1.6%）、阴沟肠杆菌3株（1.2%）、鲍曼不动杆菌2株（0.8%）。这些革兰阴性杆菌对美罗培南的敏感性最高（98.5%），其次为亚胺培南（97.9%）、阿米卡星（97.5%）、哌拉西林/他唑巴坦（94.7%）、头孢美唑（93.7%）、头孢哌酮/舒巴坦（93%）。不同细菌对抗生素的敏感性不同。肝硬化患者一旦发生社区获得性血流感染，应尽早使用高敏感抗生素。头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、亚胺培南和美罗培南可作为一线经验性抗生素，必要时应考虑联合用药。
