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原发性/转移性肝癌患者经肝动脉化疗栓塞术或消融术后发生肝脓肿的病原菌分布及耐药性分析
Pathogen distribution and drug resistance in liver cancer patients with liver abscess after transarterial chemoembolization or ablation
文章发布日期:2019年12月20日  来源:  作者:蔡妙甜,梁连春  点击次数:458次  下载次数:109次

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【摘要】:目的 探讨经肝动脉化疗栓塞术(TACE)或消融术治疗原发性或转移性肝癌后发生肝脓肿的病原菌分布特点及耐药情况,为临床合理使用抗菌药物提供依据。方法 回顾性分析2011年1月-2018年12月北京佑安医院收治的经TACE/消融治疗后发生肝脓肿的原发性肝癌或转移性肝癌患者的肝脓液、血液培养分离菌株及药敏试验结果。计数资料组间比较采用χ2检验。结果 共纳入49例患者,其中TACE组15例,消融组34例。TACE组共检出35株病原菌(肝脓液25株,血液10株),革兰阴性菌、革兰阳性菌及真菌分别占54.3%、40%及5.7%;肝脓液培养分离病原菌(n=25)主要为肺炎克雷伯菌(n=5)、屎肠球菌(n=5),铜绿假单胞菌(n=3)等;血培养分离病原菌(n=10)主要为屎肠球菌(n=4)、大肠埃希菌(n=1)、枸橼酸杆菌(n=1)等。消融组共检出64株病原菌(肝脓液43株,血液21株),革兰阴性菌、革兰阳性菌及真菌分别占59.4%、39.1%及1.6%;肝脓液培养分离病原菌(n=43)主要为大肠埃希菌(n=10)、肺炎克雷伯菌(n=9)、屎肠球菌(n=4)等;血培养分离病原菌(n=21)主要为肺炎克雷伯菌(n=5)、大肠埃希菌(n=3)、粪肠球菌(n=3)等。药敏结果显示,肺炎克雷伯菌及大肠埃希菌中产超广谱 β-内酰胺酶菌株分别占26.3%(5/19)及43.8%(7/16),耐碳青霉烯类菌株分别占10.5%(2/19)及12.5%(2/16)。肺炎克雷伯菌对第三代头孢菌素、喹诺酮类、氨基糖苷类、哌拉西林/他唑巴坦及碳青霉烯类药物耐药率≤10.5%;大肠埃希菌对所检测头孢菌素、喹诺酮类、青霉素类等药物耐药率为43.8%~62.5%,对哌拉西林/他唑巴坦、碳青霉烯类耐药率分别为18.8%、12.5%。屎肠球菌及粪肠球菌中万古霉素耐药菌株分别占13.3%(2/15)及0,利奈唑胺耐药菌株分别占13.3%(2/15)及28.6%(2/7),未检出替考拉宁耐药菌株。结论 肝癌TACE/消融术后肝脓肿致病菌以肺炎克雷伯菌、大肠埃希菌、屎肠球菌及粪肠球菌等为主,治疗时应根据相应药敏结果选择用药,减少耐药菌产生。
【Abstract】:Objective To investigate the pathogen distribution characteristics and drug resistance in patients with liver abscess after transarterial chemoembolization (TACE) or ablation for liver cancer, and to provide a basis for rational use of antibacterial agents in clinical practice. Methods A retrospective analysis was performed for the results of the strains isolated from liver pus and blood culture and drug sensitivity test of the liver cancer patients who were admitted to Beijing YouAn Hospital from January 2011 to December 2018 and developed liver abscess after TACE/ablation. The Chi-square test was used for comparison of categorical data between groups. Results A total of 49 patients were enrolled, with 15 in TACE group and 34 in ablation group. A total of 35 strains of pathogenic organisms were detected in the TACE group, and Gram-negative bacteria, Gram-positive bacteria, and fungi accounted for 54.3%, 40%, and 5.7%, respectively; Klebsiella pneumoniae, Enterococcus faecium, and Pseudomonas aeruginosa were the main pathogenic bacteria isolated from liver pus culture, and Enterococcus faecalis, Escherichia coli, and Citrobacter were the main pathogenic bacteria isolated from blood culture. A total of 64 strains of pathogenic organisms were detected in the ablation group, and Gram-negative bacteria, Gram-positive bacteria, and fungi accounted for 59.4%, 39.1%, and 1.6%, respectively; Escherichia coli, Klebsiella pneumonia, and Enterococcus faecalis were the main pathogenic bacteria isolated from liver pus culture, and Klebsiella pneumoniae, Escherichia coli, and Enterococcus faecalis were the main pathogenic bacteria isolated from blood culture. Drug susceptibility results showed that in the strains of Klebsiella pneumoniae and Escherichia coli, the ESBL-producing strains accounted for 26.3% (5/19) and 43.8% (7/16), respectively, and the carbapenem-resistant strains accounted for 10.5% (2/19) and 12.5% (2/16), respectively. Klebsiella pneumoniae had a drug resistance rate of ≤10.5% to third-generation cephalosporins, quinolones, aminoglycosides, piperacillin/tazobactam, and carbapenems, and Escherichia coli had a drug resistance rate of 43.8%-62.5% to the tested cephalosporins, quinolones, and penicillins, 18.8% to piperacillin/tazobactam, and 12.5% to carbapenems. In the strains of Enterococcus faecium and Enterococcus faecalis, the vancomycin-resistant strains accounted for 13.3%(2/15) and 0, respectively, and the linezolid-resistant strains accounted for 13.3% (2/15) and 28.6% (2/7), respectively, while no teicoplanin-resistant strains were detected. Conclusion Klebsiella pneumoniae, Escherichia coli, Enterococcus faecium, and Enterococcus faecalis are the main pathogenic bacteria of liver abscess after TACE/ablation for liver cancer, and drugs should be selected based on drug susceptibility results to reduce drug-resistant strains.
【关键字】:肝肿瘤; 肝脓肿; 化学栓塞, 治疗性; 消融技术; 病原菌
【Key words】:liver neoplasms; liver abscess; chemoembolization,therapeutic; ablation techniques; pathogen
【引证本文】:CAI MT, LIANG LC. Pathogen distribution and drug resistance in liver cancer patients with liver abscess after transarterial chemoembolization or ablation[J]. J Clin Hepatol, 2020, 36(1): 118-122. (in Chinese)
蔡妙甜, 梁连春. 原发性/转移性肝癌患者经肝动脉化疗栓塞术或消融术后发生肝脓肿的病原菌分布及耐药性分析[J]. 临床肝胆病杂志, 2020, 36(1): 118-122.

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