a State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine , Zhejiang University , Hangzhou , Zhejiang Province , China.
Expert Rev Gastroenterol Hepatol. 2018 Nov;12(11):1167-1174. doi: 10.1080/17474124.2018.1515627. Epub 2018 Sep 5.
The purpose of this study is to describe the epidemiological features of bacterial infections caused by multidrug-resistant (MDR) bacteria in cirrhotic patients and their impact on mortality.
A retrospective study of cirrhotic patients with culture-confirmed bacterial infections was performed between 2011 and 2017.
A total of 635 episodes in 563 patients with cirrhosis were included. Bacterial infections caused by MDR isolates accounted for 44.1% (280/635) of the episodes, nearly half of which were hospital acquired (48.4%). The most common MDR isolation site was the respiratory tract (36.4%, 102 episodes), followed by the abdominal cavity (35.4%, 99 episodes). Of the MDR isolates, carbapenem-resistant Enterobacteriaceae (CRE) (91 episodes) were the most common. Patients infected with MDR bacteria had significantly higher mortality than those not infected (25.1% vs 17.4%, p = 0.025). However, this increased mortality could be largely attributed to methicillin-resistant Staphylococcus aureus (MRSA). After adjustment for age, sex, and the model for end-stage liver disease (MELD) score, only MRSA infection was an independent risk factor for 28-day mortality in the multivariable Cox proportional hazard regression model analysis (HR, 2.964, 95% CI (1.175-7.478), p = 0.021).
MDR bacterial infections, especially CRE, have become frequent in patients with cirrhosis in recent years, with MRSA infections significantly increasing short-term mortality.
本研究旨在描述肝硬化患者中多重耐药（MDR）细菌引起的细菌感染的流行病学特征及其对死亡率的影响。
对 2011 年至 2017 年间经培养证实的肝硬化合并细菌感染患者进行回顾性研究。
共纳入 563 例肝硬化患者的 635 例次细菌感染。MDR 分离株引起的细菌感染占 635 例次的 44.1%（280/635），近一半为医院获得性感染（48.4%）。最常见的 MDR 分离部位是呼吸道（36.4%，102 例次），其次是腹腔（35.4%，99 例次）。MDR 分离株中，碳青霉烯类耐药肠杆菌科细菌（CRE）（91 例次）最为常见。感染 MDR 细菌的患者死亡率明显高于未感染的患者（25.1%比 17.4%，p=0.025）。然而，这种增加的死亡率在很大程度上归因于耐甲氧西林金黄色葡萄球菌（MRSA）。在校正年龄、性别和终末期肝病模型（MELD）评分后，只有 MRSA 感染是多变量 Cox 比例风险回归模型分析中 28 天死亡率的独立危险因素（HR，2.964，95%CI（1.175-7.478），p=0.021）。
近年来，MDR 细菌感染，尤其是 CRE，在肝硬化患者中已变得频繁，MRSA 感染显著增加了短期死亡率。
