乙型肝炎肝硬化伴肺部感染患者分离株菌种及药敏分析

摘要/Abstract

摘要： 目的分析乙型肝炎肝硬化伴肺部感染患者分离株菌种及药敏。方法回顾性分析123例河池市人民医院收治的乙型肝炎肝硬化伴肺部感染患者的临床资料,收集痰液标本,分析分离株菌种分布情况,并进行药敏试验。结果病原菌中60.40%为革兰阴性菌,38.26%为革兰阳性菌,1.34%为真菌,革兰阴性菌为主要病原菌。患者革兰阴性菌和革兰阳性菌主要分离菌株均对多种抗菌药物耐药,肺炎克雷伯菌对厄他培南、亚胺培南和阿米卡星敏感率＞70%,大肠杆菌对头孢他啶、氨曲南、厄他培南、亚胺培南和阿米卡星敏感率＞70%,金黄色葡萄球菌对万古霉素、环丙沙星、左氧氟沙星等敏感率＞70%,凝固酶阴性葡萄球菌对万古霉素敏感率＞70%。肺炎克雷伯菌及大肠杆菌菌株有一定超广谱β-内酰胺酶(ESBL)阳性率(＞30%)及碳青霉烯酶阳性率(＜30%)。结论乙型肝炎肝硬化伴肺部感染患者分离株菌种以革兰阴性菌为主,革兰阴性及革兰阳性主要分离菌株均对多种抗菌药物耐药,肺炎克雷伯菌及大肠杆菌菌株存在ESBL阳性。

关键词: 乙型肝炎, 肝硬化, 肺部感染, 分离株, 药敏, 水解酶, 生物被膜

Abstract: Objective To observe the isolated bacterial strains and drug sensitivity in patients with hepatitis B-related cirrhosis comorbided with pulmonary infection.Methods The clinical data of 123 cases of patients with hepatitis B-related cirrhosis complicated with pulmonary infection were retrospectively analyzed. Sputum samples were collected from all patients. The distribution of isolated bacterial strains and drug sensitivity were analyzed.Results Of the pathogenic bacteria, there were 60.40% of gram negative bacteria, 38.26% of gram positive bacteria, and 1.34% of fungi. Gram-negative bacteria were the main pathogens. The main isolated strains of gram-negative bacteria and gram-positive bacteria were resistant to a variety of antibiotics, the sensitivity rates of Klebsiella pneumoniae to ertapenem, imipenem and amikacin were more than 70%. The sensitivity rates of Escherichia coli to ceftazidime, aztreonam, ertapenem, imipenem and amikacin were more than 70%. The sensitivity rates of Staphylococcus aureus to vancomycin, ciprofloxacin and Levofloxacin etc. were more than 70%. The sensitivity rates of coagulase negative Staphylococcus to vancomycin were more than 70%. Klebsiella pneumoniae and Escherichia coli strains have certain positive rates of extended-spectrum β-lactamase (ESBL) (>30%) and carbapenemase (<30%).Conclusion The strains isolated from patients with hepatitis B related cirrhosis and pulmonary infection are mainly gram-negative bacteria. Gram-negative and gram-positive isolates are resistant to a variety of antibiotics. Klebsiella pneumoniae and Escherichia coli strains are positive for ESBL.

Key words: Hepatitis B, Cirrhosis, Pulmonary infection, Isolated strains, Drug sensitivity

姚朝光, 蓝婧, 黄理, 陈丽芬, 覃冬林, 黄洁婕, 黄佳. 乙型肝炎肝硬化伴肺部感染患者分离株菌种及药敏分析[J]. 肝脏, 2022, 27(8): 881-883.

YAO chao-guang, LAN Jing, HUANG Li, CHEN Li-fen, QIN Dong-lin, HUANG Jie-jie, HUANG Jia. An analysis on isolated strains and drug sensitivity in patients with hepatitis B-related cirrhosis comorbided with pulmonary infection[J]. Chinese Hepatolgy, 2022, 27(8): 881-883.

参考文献

[1] 程爱琼, 施伎蝉, 宁洪叶, 等. 肝硬化患者合并肺部感染痰培养中微生物谱及抗生素耐药分析. 中国卫生检验杂志, 2020, 30(21): 2598-2601.
[2] Wencewicz TA. Crossroads of Antibiotic Resistance and Biosynthesis. J Mol Biol, 2019, 431(18): 3370-3399.
[3] Lerminiaux NA, Cameron A D S. Horizontal transfer of antibiotic resistance genes in clinical environments. Can J Microbiol, 2019, 65(1): 34-44.
[4] 中华医学会肝病学分会, 中华医学会感染病学分会. 慢性乙型肝炎防治指南(2015更新版). 胃肠病学, 2016, 21(4): 219-240.
[5] 中华人民共和国卫生部. 医院感染诊断标准(试行). 中华医学杂志, 2003, 15(7): 460-465.
[6] Jones RN. NCCLS guidelines:revised performance standards for antimicrobial disk susceptibility tests. Antimicrobic Newsletter, 1984, 1(8): 64-65.
[7] 赵建兰, 许东风, 徐慧, 等. 肺部感染患者多药耐药菌耐药性与转归. 中华医院感染学杂志, 2019, 29(3): 377-379, 383.
[8] 赵丛林, 张伯鹏, 邹宁. 肝硬化患者合并医院内肺部感染的病原菌分布及危险因素. 临床与病理杂志, 2020, 40(8): 2080-2084.
[9] Otsuka Y. Potent Antibiotics Active against Multidrug-Resistant Gram-Negative Bacteria. Chem Pharm Bull (Tokyo), 2020, 68(3): 182-190.
[10] Guo W, Sun FJ, Liu F, et al. Antimicrobial resistance surveillance and prediction of Gram-negative bacteria based on antimicrobial consumption in a hospital setting: A 15-year retrospective study. Medicine (Baltimore), 2019, 98(37): e17157.
[11] Wasyl D, Zajac M, Lalak A, et al. Antimicrobial Resistance in Escherichia coli Isolated from Wild Animals in Poland. Microb Drug Resist, 2018, 24(6): 807-815.[12] 李德雨. 耐碳青霉烯类药物大肠杆菌耐药机制的研究进展. 临床与病理杂志, 2019, 39(3): 673-678.
[13] Durao P, Balbontin R, Gordo I, et al. Evolutionary Mechanisms Shaping the Maintenance of Antibiotic Resistance. Trends Microbiol, 2018, 26(8): 677-691.
[14] 廖凤慧, 王鹤, 刘学佳, 等. 近10年我院金黄色葡萄球菌耐药性研究. 中国医科大学学报, 2018, 47(1): 42-47.
[15] 田英杰, 于慧, 王占黎. 金黄色葡萄球菌耐药性及相关耐药基因分析. 中国中西医结合急救杂志, 2019, 26(2): 197-200.
[16] Sharma M, Sapkota J, Jha B, et al. Biofilm Formation and Extended-Spectrum Beta-Lactamase Producer among Acinetobacter Species Isolated in a Tertiary Care Hospital: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc, 2019, 57(220): 424-428.