在ICU外的非补偿性肝硬化中,多药耐药殖民预测了感染和不良结果
María Hernández-Tejero1,2,3, Marco Pavesi4, Fátima Aziz1
1Liver Unit, Hospital Clinic, IDIBAPS and CIBEREHD, Barcelona, Spain.
JHEP reports : innovation in hepatology
|February 23, 2026
概括
复杂耐药生物体 (MDRO) 殖民在ICU以外的肝硬化患者中很常见,并预测感染和死亡率. 监测和管理应该超出临床护理范围,以减少患者的发病率和死亡率.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 传染性疾病 传染性疾病
- 临床微生物学 临床微生物学
- 流行病学 流行病学
背景情况:
- 由多药物 (MDROs) 或广泛耐药 (XDROs) 生物体引起的感染是全球日益严重的健康问题,特别是在肝硬化患者中.
- 虽然MDRO殖民是重症监护病房 (ICU) 感染的已知风险因素,但其在非ICU环境中对不补偿性肝硬化患者的重要性仍未得到充分研究.
研究的目的:
- 为了确定MDRO殖民的流行率,动态和临床影响,在ICU以外的无补偿性肝硬化患者.
- 在这个患者群体中确定MDRO殖民化和随后感染的预测因素.
主要方法:
- 这是一项从2017年至2020年进行的单一中心前性研究,招募了408名进入病房 (n=272) 或ICU (n=136) 的去补偿性肝硬化患者.
- 在入院时收集了直肠和鼻腔抽样,并在每周一次,长达12个月,以追踪殖民动态.
- 分析重点是病房患者,比较与ICU队列的殖民率,感染发病率,耐药性概况和结果.
主要成果:
- 基线直肠MDRO殖民在病房 (23%) 和ICU (17%) 患者中普遍存在,在1年后增加到相似的率 (39%对43%).
- 在病房患者中,殖民 (基线或随访) 与殖民菌株的MDRO感染 (52-55% vs. 11-19%) 和较高的死亡率 (60% vs. 22%) 有显著的关联.
- 基线 (HR 9.6) 和后续殖民 (HR 4.4) 都独立预测了感染,而在任何时间点的殖民都预测了死亡率 (HR 2.07). 最近的急性-慢性肝衰竭预测了殖民和感染.
结论:
- 在非ICU肝硬化患者中,MDRO殖民是频繁且具有临床意义的,作为感染和死亡率的预测因素.
- 将有针对性的监测和抗生素管理计划扩展到重症监护机构之外,对于降低这些脆弱患者的感染相关发病率和死亡率至关重要.
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