Gastroenterology and Hepatology Department, University of Medicine and Pharmacy "Iuliu Hatieganu", 19-21 Croitorilor Street, Cluj-Napoca 400162, Romania.
Microbiology Department, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania.
Dig Liver Dis. 2022 Oct;54(10):1385-1391. doi: 10.1016/j.dld.2022.05.011. Epub 2022 Jun 19.
Multidrug-resistant organisms are an increasing concern in patients with decompensated cirrhosis.
We aimed to evaluate the prevalence of infections with carbapenem-resistant Enterobacteriaceae in patients with decompensated cirrhosis.
Patients with decompensated cirrhosis admitted to ICU were included. The isolated Enterobacteriaceae strains were tested for carbapenemase-producing genes using the Roche LightMix® Modular VIM/IMP/NDM/GES/KPC/OXA48-carbapenemase detection kit.
48 culture-positive infections were registered in 75 patients with acutely decompensated cirrhosis. Thirty patients contracted a second infection. 46% of bacteria isolated at admission and 60% of bacteria responsible for infections identified during ICU-stay were multiresistant. ESBL+ Enterobacteriaceae were predominant at admission, while carbapenem-resistance was dominant in both Enterobacteriaceae and Non-Fermenting-Gram-Negative Bacteria responsible for infections diagnosed during hospitalisation. OXA 48 or KPC type carbapenemases were present in 30% of the analyzed Enterobacteriaceae and in 40% of the phenotypically carbapenem-resistant Klebsiella pneumoniae strains. The length of ICU stay was a risk-factor for a second infection (p=0.04). Previous carbapenem usage was associated with occurence of infections with carbapenem-resistant Gram-negative bacteria during hospitalization (p=0.03).
The prevalence of infections with carbapenem-resistant Enterobacteriaceae is high in patients with decompensated cirrhosis admitted to ICU. Carbapenemase-producing genes in Enterobacteriaceae in our center are bla and bla.
在失代偿性肝硬化患者中，多药耐药菌是一个日益令人关注的问题。
我们旨在评估失代偿性肝硬化患者中感染碳青霉烯类耐药肠杆菌科的流行率。
纳入入住 ICU 的失代偿性肝硬化患者。使用罗氏 LightMix® Modular VIM/IMP/NDM/GES/KPC/OXA48-碳青霉烯酶检测试剂盒检测分离的肠杆菌科菌株中是否存在产碳青霉烯酶基因。
75 例急性失代偿性肝硬化患者中登记了 48 例培养阳性感染。30 例患者发生了二次感染。入院时分离的细菌中 46%和入住 ICU 期间确定的感染相关细菌中 60%为多耐药菌。入院时以 ESBL+肠杆菌科为主，而在住院期间诊断的肠杆菌科和非发酵革兰氏阴性菌感染中，碳青霉烯耐药为主。在分析的肠杆菌科中，30%存在 OXA 48 或 KPC 型碳青霉烯酶，40%表型碳青霉烯耐药肺炎克雷伯菌菌株存在该酶。入住 ICU 时间长是二次感染的危险因素（p=0.04）。住院期间发生碳青霉烯类耐药革兰氏阴性菌感染与之前使用碳青霉烯类药物有关（p=0.03）。
入住 ICU 的失代偿性肝硬化患者中，感染碳青霉烯类耐药肠杆菌科的流行率较高。我们中心肠杆菌科中的碳青霉烯酶基因是 bla 和 bla。
