中国肝硬化患者细菌性感染的临床、微生物学和抗生素治疗特点:一项多中心研究

IF 4.2 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Xiuding Zhang, Haoda Weng, Qinzhi Deng, Min Deng, Xuwei Wu, Zuxiong Huang, Shourong Liu, Rui Wu, Chunlian Ma, Yao Xu, Jianfeng Zhong, Jie Yang, Yinxia Wu, Huajiang Shen, Feng Ding, Fang Wang, Xuezhen Zhai, Chunxian Peng, Haotang Ren, Jie Jin, Xiangfei Xu, Xiaofei Li, Xiaoting Ye, Guoqing Qian, Shuilin Sun, Xuebing Yao, Haifeng Miao, Qianggu Xiao, Shaoheng Ye, Qing Zhang, Xinyi Xu, Xia Yu, Yue Yu, Yan Lan, Huilan Tu, Xianbin Xu, Xinrong Zhang, Rui Huang, Xiaohan Qian, Qiao Yang, Jifang Sheng, Yu Shi
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引用次数: 0

摘要

背景和目的:中国肝硬化细菌感染的流行病学资料仍然有限。因此,我们旨在开展一项多中心研究,以调查中国肝硬化合并细菌感染患者的特征和结局。方法:我们回顾性地纳入了2018年1月至2024年9月期间来自中国24家医院的1438名肝硬化合并细菌或真菌感染的住院成年患者。收集了人口统计学、临床特征、微生物学、治疗和结果的数据。结果:共记录感染1783例,其中首次感染1668例,二次感染115例。社区获得性感染居多(86.6%)。肺炎是最常见的感染类型(26.7%),其次是自发性细菌性腹膜炎(19.5%)和自发性菌血症(14.1%)。从620例患者中分离出754种病原菌,肺炎克雷伯菌(20.1%)和大肠埃希菌(21.7%)的检出率相近。多药耐药菌(MDR)占所有分离株的41.0%,其中产β-内酰胺酶的广谱大肠杆菌是最常见的MDR菌株(占患者的8.9%)。与全球研究相比,该队列患者对欧洲肝脏研究协会(European Association for the Study of the Liver)经验抗生素治疗指南的依从性显著降低(21.5% vs. 61.2%, P < 0.001),临床解决率也较低(63.5% vs. 79.8%, P < 0.001)。结论:中国肝硬化患者细菌感染的临床和微生物学特征与其他地区报道的有很大不同。这些发现突出了针对特定区域的管理和预防战略的必要性,特别是考虑到不断变化的微生物环境、耐多药高流行率和次优抗生素做法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Clinical, Microbiological, and Antibiotic Treatment Characteristics of Bacterial Infections in Patients with Liver Cirrhosis in China: A Multicenter Study.

Clinical, Microbiological, and Antibiotic Treatment Characteristics of Bacterial Infections in Patients with Liver Cirrhosis in China: A Multicenter Study.

Background and aims: Epidemiological data on bacterial infections in cirrhosis in China remain limited. Therefore, we aimed to conduct a multicenter study to investigate the characteristics and outcomes of patients with cirrhosis and bacterial infections in China.

Methods: We retrospectively enrolled 1,438 hospitalized adult patients with cirrhosis and bacterial or fungal infections from 24 hospitals across China between January 2018 and September 2024. Data on demographics, clinical features, microbiology, treatment, and outcomes were collected.

Results: A total of 1,783 infection episodes were recorded, including 1,668 first infections and 115 second infections. Most infections were community-acquired (86.6%). Pneumonia was the most common infection type (26.7%), followed by spontaneous bacterial peritonitis (19.5%) and spontaneous bacteremia (14.1%). Among 754 pathogens isolated from 620 patients, Klebsiella pneumoniae (20.1%) was nearly as common as Escherichia coli (21.7%). Multidrug-resistant (MDR) organisms accounted for 41.0% of all isolates, with extended-spectrum β-lactamase-producing Escherichia coli being the most prevalent MDR strain (8.9% of patients). Adherence to empirical antibiotic treatment guidelines from the European Association for the Study of the Liver was significantly lower in this cohort compared to the global study (21.5% vs. 61.2%, P < 0.001), accompanied by a lower clinical resolution rate (63.5% vs. 79.8%, P < 0.001).

Conclusions: The clinical and microbiological characteristics of bacterial infections in patients with cirrhosis in China differ substantially from those reported in other regions. These findings highlight the need for region-specific management and prevention strategies, particularly in light of the changing microbiological landscape, high MDR prevalence, and suboptimal antibiotic practices.

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来源期刊
Journal of Clinical and Translational Hepatology
Journal of Clinical and Translational Hepatology GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
6.40
自引率
2.80%
发文量
496
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