传染病信息

目的 探讨终末期肝病(end-stage of liver disease, ESLD)合并细菌感染患者的病原菌分布和耐药性现状。方法 选取2021年1月1日至2025年4月30日郴州市第二人民医院收治的238例ESLD合并细菌感染(病原学确诊)的患者为研究对象，回顾性分析上述患者的致病病原菌分布和药物敏感性试验结果。结果 238例ESLD合并细菌感染患者中共分离到251株病原菌菌株，革兰阴性菌(G~-菌)126株，占50.20%，其中大肠埃希菌和肺炎克雷伯菌共95株，占G~-菌的75.40%；革兰阳性球菌(G⁺菌)120株，占47.81%，其中金黄色葡萄球菌和表皮葡萄球菌32株，占G⁺菌的26.67%；结核分枝杆菌5株，占1.99%。多重耐药菌株(multidrug-resistant strains, MDR)76株，占30.28%。在G~-致病菌中，耐药率排前3位的抗菌药物是氨苄西林、复方磺胺甲噁唑、头孢呋辛；在G⁺致病菌中，耐药率排前3位的抗菌药物是青霉素、红霉素、克林霉素；产超广谱β内酰胺酶(extended spectrum beta lactamase, ESBLs)菌共检出26株，ESBLs(+)菌检出率为10.36%；耐甲氧西林金黄色葡萄球菌(methicillin-resistant Staphylococcus aureus, MRSA)检出2株，MRSA(+)菌检出率为0.80%。结论 经病原学确诊的ESLD合并细菌感染患者的病原菌G~-菌略高于G⁺菌，但G⁺菌呈增长态势，且菌种呈现多样化；MDR占比为30.28%，耐药率较高，临床医生可依据病原菌种类和药敏结果选择抗感染药物。

Objective To investigate the distribution and antibiotic resistance profiles of pathogenic bacteria in patients with end-stage liver disease(ESLD) complicated by bacterial infections. Methods A total of 238 ESLD patients with bacterial infections(pathogenically confirmed) at the Second People's Hospital of Chenzhou from January 1, 2021 to April 30, 2025 were selected as the study subjects. The results of the main pathogens and drug susceptibility tests were retrospectively analyzed. Results A total of 251 pathogenic strains were isolated from 238 patients with ESLD bacterial infection. There were 126 strains of Gram-negative bacteria(G~-bacteria), accounting for 50.20%, of which 95 strains were Escherichia coli and Klebsiella pneumoniae, accounting for 75.40% of G~-bacteria. There were 120 strains of Gram-positive cocci(G⁺ bacteria), accounting for 47.81%, including 32 strains of Staphylococcus aureus and Staphylococcus epidermidis(representing 26.67% of G⁺ bacteria). There were 5 strains of Mycobacterium tuberculosis, accounting for 1.99%. There were 76 multidrug-resistant strains(MDR), accounting for 30.28%. Among the G-bacteria, the top three drug resistance rates were for ampicillin, compound sulfamethoxazole, and cefuroxime; and among G⁺ bacteria, the top three drug resistance rates were for penicillin, erythromycin, and clindamycin. A total of 26 extended spectrum beta lactamase(ESBLs)-producing strains were detected, and the detection rate of ESBLs(+) bacteria was 10.36%; additionally, 2 strains of methicillin-resistant Staphylococcus aureus(MRSA) were detected, and the detection rate of MRSA(+) bacteria was 0.80%. Conclusion In pathogenically confirmed ESLD patients with bacterial infections, G~-bacteria are slightly more prevalent than G⁺ bacteria, though G⁺ bacteria maintain a substantial presence with increasingly diversified species. MDR accounts for 30.28%, with a relatively high drug resistance rate. Clinicians can choose targeted anti-infective drugs based on the types of pathogens and antimicrobial susceptibility results.