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老年肝胆疾病患者大肠埃希菌血流感染的临床特点分析
Clinical analysis of bloodstream infections caused by Escherichia coli in elderly patients with hepatobiliary disease
文章发布日期:2015年04月15日  来源:  作者:王钱,鲍春梅,何卫平,等  点击次数:1610次  下载次数:304次

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【摘要】:目的分析老年肝胆疾病患者大肠埃希菌血流感染的临床特点及耐药性,为临床治疗提供依据。方法回顾性分析2009年-2012年于解放军三〇二医院住院的57例老年肝胆疾病患者血流感染大肠埃希菌的临床特点及药敏试验结果。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验。 结果57例老年肝胆疾病患者血流感染大肠埃希菌,其中基础疾病以肝硬化为主,感染来源以自发性细菌性腹膜炎为主,超广谱β-内酰胺酶(ESBL)阳性24株,阳性率为42.1%。二者在年龄、性别、基础疾病、原发病灶、体温峰值、白细胞计数及中性粒细胞百分比等方面比较,差异均无统计学意义(P值均>0.05)。除亚胺培南/西司他丁、美罗培南、头孢哌酮/舒巴坦、替卡西林/克拉维酸及米诺环素外,ESBL阳性大肠埃希菌的耐药性均高于ESBL阴性大肠埃希菌,差异具有统计学意义(P值均<0.05)。发生感染性休克、肝性脑病及急性肾损伤患者的病死率要高于无发生者,差异有统计学意义(χ2值分别为9541、7622、9733,P值均<0.05)。结论老年肝胆疾病患者血流感染大肠埃希菌ESBL阳性耐药性高,出现严重并发症者预后不良,应尽早联合抗感染治疗及预防,控制严重并发症以降低病死率。
【Abstract】:ObjectiveTo investigate the clinical characteristics and drug resistance in elderly patients with hepatobiliary disease and bloodstream infections caused by Escherichia coli, and to provide a basis for clinical therapy. MethodsA retrospective analysis was performed on the clinical characteristics and drug susceptibility of 57 elderly inpatients with hepatobiliary disease and bloodstream infections caused by Escherichia coli in our hospital from 2009 to 2012. Comparison of continuous data between the two groups was made by t test, and comparison of categorical data was made by chi-square test. ResultsThe majority of patients had liver cirrhosis, and spontaneous bacterial peritonitis was the major infection source. A total of 57 strains of Escherichia coli were isolated from elderly patients with hepatobiliary disease, and 24 (421%) out of them were positive for extended-spectrum β-lactamase (ESBL). ESBL-positive strains had a significantly higher level of drug resistance than ESBL-negative strains (P<0.05), except for imipenem/cilastatin, meropenem, cefoperazone/sulbactum, ticarcillin/clavulanate, and minocycline. However, there were no significant differences in age, gender, basic disease, infection source, peak body temperature, white blood cell count, and the percentage of neutrophils between the ESBL-positive group and the ESBL-negative group (P>0.05). The case-fatality rate in patients with septic shock, hepatic encephalopathy, or acute kidney injury was significantly higher than that in patients with no complications (χ2=9541,7622,9733,respectively, P<0.05). ConclusionElderly patients with hepatobiliary disease and bloodstream infections caused by ESBL-positive Escherichia coli had a high level of drug resistance and a poor prognosis for severe complications. Antibiotic therapy combined with prevention and control of severe complications should be taken as early as possible to reduce the case-fatality rate.
【关键字】:肝疾病;胆道疾病;肠致病性大肠杆菌;感染;β内酰胺酶类;老年人
【Key words】:liver diseases; biliary tract diseases; enteropathogenic escherichia coli; infection; beta-lactamases; aged
【引证本文】:

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