[Etiological characteristics and drug resistance in patients with hepatitis B virus associated acute -on-chronic liver failure complicated with abdominal infection].

Abstract

Objective: To analyze the distribution of pathogenic microorganisms, drug resistance and influencing factors in patients with hepatitis B virus associated acute -on-chronic liver failure (HBV-ACLF) complicated with abdominal infection (IAI). Methods A retrospective analysis was conducted on 282 HBV-ACLF patients admitted to the Hepatobiliary Internal Medicine Department of Mengchao Hepatobiliary Hospital of Fujian Medical University, from May 2019 to December 2022, with 141 patients who had IAI and positive bacterial culture as the infected group; 141 non-infected patients admitted during the same period were used as the non-infected group. The clinical data, laboratory test results, pathogen species and drug sensitivity test results of the patients were collected, and the influencing factors of IAI in HBV-ACLF patients were analyzed by Logistic regression analysis. Results: A total of 204 pathogenic bacteria were detected in the infection group, including 115 Gram-negative bacteria (56.37%), 74 Gram-positive bacteria (36.28%) and 15 fungi (7.35%). The most frequently detected bacterial genera were Escherichia coli (21.57%, 44/204), Klebsiella pneumoniae (12.25%, 25/204), Enterococcus faecium (6.37%, 13/204), Staphylococcus aureus (5.39%, 11/204) and Staphylococcus epidermidis (4.90%, 10/204). The results of drug sensitivity tests showed that the resistance rates of Escherichia coli and Klebsiella pneumoniae to levofloxacin and ciprofloxacin were over 50% and 30% respectively; the resistance rate of Pseudomonas aeruginosa to carbapenems (meropenem and imipenem) was 60.00%; the resistance rates of Acinetobacter baumannii to meropenem and imipenem were 100% and 50.00% respectively; the resistance rates of Enterococcus faecium and Enterococcus faecalis to penicillin were 100% and 33.33% respectively; and the resistance rates of Staphylococcus aureus to penicillin (77.78%) and oxacillin (33.33%) were relatively high..The results of the multivariate unconditional logistic regression analysis showed that puncture and drainage (OR=17.90, 95% CI: 7.94~43.42, P< 0.001), procalcitonin (OR=3.23, 95% CI: 1.56~8.98, P=0.012), C-reactive protein (OR=1.05, 95% CI: 1.02~1.00, P=0.003), and age (OR=1.06, 95% CI: 1.02~1.10, P=0.001) were independent risk factors for IAI in patients with HBV-ACLF. Conclusions The pathogenic microorganisms of HBV-ACLF patients with IAI were mainly enterobacteriaceae bacteria and enterococcus. Puncture drainage, procalcitonin, C-reactive protein and age were independent risk factors for IAI in HBV-ACLF patients. Early intervention to avoid the increase of inflammatory in dicators is an effective measure to prevent abdominal infection in HBV-ACLF patients.