摘要
目的:分析医院肝硬化(hepatic cirrhosis,HC)患者并发肺部感染(pulmonary infection,PI)的病原学特点与危险因素,为HC患者防治PI提供参考。方法:选取2020年2月—2021年10月镇平县人民医院呼吸内科收治的424例HC患者作为研究对象,统计和分析患者的PI发生状况,以及发生PI的病原学特点与危险因素。结果:424例HC患者中发生PI的有66例,其发生率为15.57%;66例并发PI患者痰液标本中共分离出76株菌株,其中革兰阴性菌45株(占59.21%,以大肠埃希菌、肺炎克雷伯菌为主)、革兰阳性菌29株(占38.16%,以金黄色葡萄球菌为主)和真菌2株(占2.63%,主要是白假丝酵母);药敏试验结果显示,大肠埃希菌对妥布霉素、庆大霉素、亚胺培南、阿米卡星的耐药率均为0.00%,肺炎克雷伯菌对所试抗菌药物的耐药率均较低(<20.00%);回归分析结果显示,HC患者并发PI与年龄、是否病毒性肝炎、有无侵入性操作、住院时长和肝功能Child-Pugh分级有关(P<0.05),其中年龄≥60岁、有侵入性操作和肝功能Child-Pugh分级为C级是患者发生PI的独立危险因素(P<0.05)。结论:HC患者存在一定的PI发生风险,引发PI的病原菌主要为革兰阴性菌,PI的发生与年龄、侵入性操作和肝功能Child-Pugh分级关系密切,临床针对存在高危风险的HC患者应加强监测和管理,避免和减少PI的发生,以确保HC的后续治疗。
Objective:To analyze the etiological characteristics and risk factors of pulmonary infection(PI)in patients with liver cirrhosis(HC),and provide reference for the prevention and treatment of PI in HC patients.Methods:A total of 424 patients with HC admitted to the Department of Respiratory Medicine of the hospital from February 2020to October 2021 were selected as the study subjects,and the incidence of PI as well as the etiological characteristics and risk factors of PI were statistically analyzed.Results:A total of 66 of 424 patients with HC had PI,with the incidence rate of 15.57%.A total of 76 strains were isolated from sputum samples of 66 patients with PI,including 45 strains of Gram-negative bacteria(accounting for 59.21%,mainly Escherichia coli and Klebsiella pneumoniae),29 strains of Grampositive bacteria(accounting for 38.16%,mainly Staphylococcus aureus)and 2 strains of fungi(accounting for 2.63%,mainly Candida albicans).The results of drug sensitivity test showed that the drug resistance rate of Escherichia coli to tobramycin,gentamicin,imipenem and amikacin was 0.00%,while the drug resistance rate of Klebsiella pneumoniae to all the tested antibacterial drugs was low(less than 20.00%).The results of regression analysis showed that the complication of PI in patients with HC was related to age,viral hepatitis,invasive procedures,length of hospitalization and Child-Pugh grade of liver function(P<0.05).Age greater than or equal to 60 years,invasive procedures and Grade C of Child-Pugh grade of liver function were independent risk factors for the development of PI(P<0.05).Conclusion:Patients with HC are at risk of PI,the pathogens causing PI are mainly Gram-negative bacteria,and the occurrence of PI is closely related to age,invasive procedures and Child-Pugh grade of liver function.Clinical monitoring and management of patients at high risk of HC should be enhanced to avoid and reduce the occurrence of PI and to ensure the follow-up treatment of HC.
作者
赵春丽
冯凤威
ZHAO Chun-li;FENG Feng-wei(Zhenping People's Hospital,Zhenping Henan 474250,China;Nanyang CentralHospital,Nanyang Henan 473000,China)
出处
《抗感染药学》
2022年第11期1554-1558,共5页
Anti-infection Pharmacy
关键词
肝硬化
肺部感染
病原学特点
危险因素
liver cirrhosis
lung infection
etiological characteristics
risk factor
作者简介
赵春丽(1987—),女,主治医师,【电子邮箱】2750447563@qq.com
