1、a ? 4Challenges and Strategies for Secondary Infections in Patients with End-stage Liver DiseasesSnD Sv DhhnD Sv. h“ahh“Epidemiology of bacterial infections in severe hepatitis051015202530354045infectiousrate%AH(298)CH(680)SH(129)LC(132)Nosocomial infections in hospitalized liver disease patients fr
2、om April 1996 to March 1999Su et al, Chin J Physician, 1999,10,37? 3 q 32%-55.3%b EVB 45 Child C) 67 b + 100%!a ? 1.Barahona-Garrido J,et al. J Clin Gastroenterol, 2010 May 52.Saab et al. Am J Gastroenterol,2009;104993-1001.3.Cheong et al. Clin Infectious Dis,2009;48:1230-1236.4. , . S e , 2008;73 S
3、BP25%-67% , 15%20%b U15%20% liver abscess 0.26%bk10%15%)12% ) 7 h q 70 M 80% 25%60%b30?h q 58.7%( Nosocomial SBP)b 00 q? a 1y1.Barahona-Garrido J,et al. J Clin Gastroenterol, 2010 May 52. Choi SH, et al Diagn Microbiol Infect Dis. 2009;63(2):160-4. ImmunodeficiencyReticuloendothelial system impaired
4、Complement decreased b z F 3 b EBQ S h p 2010 M 9 9-12 i hi h ) q% ) * 4 ! q 15%-40%b2007.1 2009.12. # 6989 z! 3379 q 4.82%b1“B ) 170 55b % b ) 50.6% | ) 46.5% Q ) 2.9%bZapater P, et al.Serum and ascitic fluid bacterial DNA: a new independent prognostic factor in noninfected patients with cirrhosis.
5、Hepatology. 2008;48(6):1924-31Fujita T. How does bacterial DNA induce liver failure in cirrhosis?Hepatology. 2009,49(4):1393-4S= d , .?Vc .ESLD5S?f2M38 12000/mm2 90Q /s MInfluence of severe hepatitis on antibacterial agents pharmacokinetics impacting PK/PD while liver failure Liver function degressi
6、on; Portosystem shunting; Protein metabolism disturbance and albumin decreasing; Ascites and water stagnation; Portal hypertension and intestinal edema; Drug-induced Liver potential Injury7 S F 3 72l H N Q? /WBC/ /8bsQ r# N$Lautenbach E,et al.Clin Infect Dis,2001,32:1162-1171.细 =Ee )% ) j “b E 00 00
7、 H 00 00 H P / 00K1y P / 00K1y 00 q Nosocomial gram-negative organisms more resistant to third-generation cephalosporins(41% vs. 10.0%) and quinolones (50.0% vs. 30.9%).Cheong HS, et Clin Infect Dis. 2009;48(9):1230-6Choi JP.et al. Clin Infect Dis. 2008 ,47(1):66-72. Saab S, et al.Oral antibiotic pr
8、ophylaxis reduces spontaneous bacterial peritonitis occurrence and improves short-term survival in cirrhosis: a meta-analysis. Am J Gastroenterol. 2009;104(4):993-1001. F 3 V$ ?Sarin S PS v F 3 1 M Vh q# ? 3 qbOf 1026 episodes of SBP in 958 patients from Jan 2000 through Dec 2006, 368 (35.9%) episod
9、es in 346 patients were caused by SBP due to E/K, isolated from ascites.7.5% patients with SBP due to ESBL-E/K 30-day mortality 46% ESBL-E/K vs. 15%. ineffective initial therapy was associated with higher 30-day mortality rate ( 61% vs. 13%,). Song KH,et al. Clinical outcomes of spontaneous bacteria
10、l peritonitis due to extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella species: a retrospective matched case-control study. BMC Infect Dis. 2009;9:41. f| & - = ESBLs 00 )F 3 7 Sd1 !170% ) 55h )S= d , .?Vc .% | $ o )24.7%v f )20%Q o )8.8%| )5.3%k X u )5.3% o )3.5% sL )2.9% f
11、/Z )82.4%ESBL-E(+)40.3%,ESBL-K(+)25.0%bho 00 qh o 00 qP 00 q : 00 q 5# 2 00 qMRS 32 74.4% a&: a aZa a 00 q bS v F 3 00 q 40%b 00 q 4.5%b s % ) )1 9% ) 00 -# H F )0d1bS= d , .?Vc . Q? 3 i SBP / ? hii Uh ) “5 “ vG* MY $ 4 F 3 $7 S 1 ! F 3 045 G- G+ F 3 h /+S v 5M1 1: F 3 P 3?rF F )0E 0 2007 M S ALF P
12、F 3 4ZE $ - _ kglucose-hydrogen-breath-test,GHBT % ) DNABact DNAa% ) DNA M% )F % ) DNAaTNF-%a NO b s 80/SOD+ !EI-Naggar M.M.,et al J Med Microl,2008,57:1533al J Med Microl,2008,57:1533-1538.Sugihara T,et al. Inter Med,2009,48:3-10.Iyer RN,et al.India J Med Microl,2009,27:159-161.4 ) * kY4 ) * kY b& - & -glucan b _ (GM k ) NO$
