文章摘要

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

作者: 1赵丛林, 2张伯鹏, 3邹宁
1 唐山市传染病医院感染科,河北 唐山 063000
2 唐山市传染病医院一病区,河北 唐山 063000
3 秦皇岛市第二医院神经内科,河北 秦皇岛 066000
通讯: 赵丛林 Email: ghb11378@163.com
DOI: 10.3978/j.issn.2095-6959.2020.08.024

摘要

目的:调查肝硬化合并医院内肺部感染的病原菌分布及危险因素。方法:选取2017年2月至2019年12月期间唐山市传染病医院收治的212例肝硬化患者为研究对象,将合并感染者纳入感染组,无医院内肺部感染者纳入无感染组;调查肝硬化合并肺部感染患者的痰液标本细菌培养情况。比较两组患者年龄、性别、病因、Child-Pugh分级、住院时间、侵入性操作、是否合并腹水及消化道出血、白蛋白情况等指标的差异。同时对肺部感染的影响因素进行logitstic回归分析。结果:212例肝硬化患者医院内肺部感染发生率16.04%,病原菌前3位分别为大肠埃希菌(18.60%)、金黄色葡萄糖球菌(16.28%)、肺炎克雷伯菌(16.28%);感染组在年龄≥60岁、病毒性肝炎、住院时间≥2周、侵入性操作、Child-Pugh分级为C级、白蛋白<28 g/L的比例明显高于无感染组,差异有统计学意义(均P<0.05)。Logitstic回归分析结果显示年龄≥60岁、侵入性操作、Child-Pugh分级为C级、白蛋白<28 g/L是肝硬化患者医院内肺部感染发生的独立危险因素(P<0.05)。结论:肝硬化患者医院内肺部感染的发生率较高,其病原菌以大肠埃希菌、金黄色葡萄球菌、肺炎克雷伯菌为主。年龄大、侵入性操作、Child-Pugh分级为C级以及白蛋白下降是肝硬化患者发生医院内肺部感染的危险因素。
关键词: 肝硬化;医院感染;肺部感染;病原菌;危险因素

Distribution and risk factors of pathogenic bacteria in patients with liver cirrhosis complicated with nosocomial pulmonary infection

Authors: 1ZHAO Conglin, 2ZHANG Bopeng, 3ZOU Ning
1 Department of Infectious Diseases, Tangshan Infectious Disease Hospital, Tangshan Hebei 063000, China
2 First Ward of Tangshan Infectious Disease Hospital, Tangshan Hebei 063000, China
3 Department of Neurology, Second Hospital of Qinhuangdao City, Qinhuangdao Hebei 06600, China

CorrespondingAuthor: ZHAO Conglin Email: ghb11378@163.com

DOI: 10.3978/j.issn.2095-6959.2020.08.024

Abstract

Objective: To investigate the distribution and risk factors of pathogenic bacteria in patients with cirrhosis and nosocomial pulmonary infection. Methods: A total of 212 cases of cirrhotic patients treated in Tangshan Infectious Disease Hospital from February 2017 to December 2019 were errolled as the study subjects. The patients who combined with nosocomial pulmonary infection, were divided into the infection group, and the patients without nosocomial pulmonary infection were assigned into the non-infection group. The sputum samples of patients with combined pulmonary infection were investigated for bacterial culture. The differences of age, gender, etiology, child Pugh grade, hospitalization time, invasive operation, ascites, gastrointestinal hemorrhage and albumin between the two groups were compared. At the same time, the influencing factors of pulmonary infection were analyzed by logitstic regression. Results: The incidence of nosocomial pulmonary infection in 212 patients with cirrhosis was 16.04%. The top 3 pathogens were Escherichia coli (18.60%), Staphylococcus aureus (16.28%), Klebsiella pneumoniae (16.28%); the infection group with incidence rate of equal or greater than 60 years old, viral hepatitis, hospital stay ≥2 weeks, invasive operation, child Pugh C grade, and albumin <28 g/L was significantly higher than those of the noninfection group (P<0.05). The logistic regression analysis showed that age ≥60 years old, invasive operation, child Pugh grade C, albumin <28 g/L were independent risk factors of nosocomial pulmonary infection in patients with cirrhosis (all P<0.05). Conclusion: The incidence of nosocomial pulmonary infection in patients with liver cirrhosis is high. The main pathogens are Escherichia coli, Staphylococcus aureus and Klebsiella pneumoniae. Age, invasive procedure, child Pugh grade C, and albumin decrease are risk factors for nosocomial pulmonary infection in patients with cirrhosis.
Keywords: liver cirrhosis; nosocomial infection; pulmonary infection; pathogenic bacteria; risk factors