Clinical Characteristic,pathogenic Characteristic And Related Factor Of End-stage Liver Disease With Infection

Objective: Through exploring the characteristics of clinic and pathogen and analyzing the related risk factor of patients with end-stage liver disease co-infection.Provide clues for diagnosing more earlier and treating more timely of patients with end-stage liver disease,thereby reducing the mortality rate of patients with end-stage liver disease.Method: Collect the clinical data of patients with end-stage liver disease who were hospitalized from January 2018 to June 2019 in the Department of Infectious Liver Diseases of the First Affiliated Hospital of Xinjiang Medical University and those patients with end-stage liver disease who were not infected during the same period,and analyzed their clinical characteristics,bacterial distribution and antibiotic resistance.Result:1.There is no statistically significant difference in etiology between the end-stage liver disease co-infected group and the non-infected group.2.Analysis of the related factors of end-stage liver disease with infection: In the end-stage liver disease infected group and the non-infected group,there were statistically significant differences in PCT、CRP、IL-6、WBC、NLR、ALT、AST、TBil、ALB、SCr、PTA、INR、D-D、MELD score.The infected group was significantly higher than the non-infected group.The results of multivariate analysis suggest that NLR、CRP、IL-6、TBil、INR、D-D are independent related factors of end-stage liver disease with infection(OR=1.03,1.02,1.03,1.02,8.42,1.01).3.Among the 219 patients with end-stage liver disease co-infected,149 cases(68.04%)had single-site infection and 70 cases(31.96%)were double-site infection.SBP was the most common single site infection(125,83.89%),followed by RTI(13,8.72%).SBP combined with RTI was the most common in double-site infections(58,82.86%),and 3 cases were SBP combined with fungal infection.In 219 patients with end-stage liver disease co-infection,there are 70 strains of bacteria in the positive culture,including 39 strains of bacilli(55.71%),19 strains of cocci(27.14%),and 12 strains(17.14%)of fungi.Among the bacilli,Escherichia coli was the most common bacterial(14,35.90%),following is Klebsiella pneumoniae(12,30.77%).Among the cocci,Enterococcus faecium was the most common bacterial(9,47.37%),followed by Staphylococcus aureus(2,10.52%)and Staphylococcus epidermidis(2,10.52%),Serratia marcescens,Staphylococcus wokerii,Staphylococcus hemolyticus,Staphylococcus capitis,Enterococcus gallinarum(group D),and Enterococcus faecalis were also cultivated.The most common fungus is Candida albicans(8,52.19%),Aspergillus,Candida krusei,and Candida glabrata also can be seen.4.Among the bacterial of patients with end-stage liver disease co-infected,those co-infected with bacilli are highly resistant to levofloxacin,ciprofloxacin,cefuroxime,and ceftriaxone,and to cefoperazone,sulbactam,amikacin,and Ropenem,imipenem,and linezolid have lower resistance rates.Complicated cocci infections are highly resistant to penicillin,levofloxacin,ciprofloxacin,erythromycin,and gentamicin,and higher resistance rates to linezolid,vancomycin,tigecycline,and compound trimethoprim low.Conclusion:1.The difference of PCT、IL-6、CRP、WBC、NLR、TBi L、ALT、AST、ALB、SCr、PTA、INR、DD 、MELD between end-stage liver disease patients with infection and without infection is statistically significant.CRP、IL-6、NLR、TBil、INR、D-D are independent related factors of end-stage liver disease with infection.2.In patients with end-stage liver disease combined with infection,single-site and double-site infections can be seen,single-site infection is the most common,SBP is the most common,and double-site infections SBP combined with lung infection is the most common.3.Bacillus infections are more common than cocci infections in end-stage liver disease.Escherichia coli is the most prevalent bacillus,and Enterococcus faecium is the most general cocci.Fungal infections can also be seen,Candida albicans is the most commonly fungus.4.The drug resistance rate to quinolones(levofloxacin、ciprofloxacin),cefuroxime and ceftriaxone was higher in different extent in patients with end-stage liver disease complicated with bacterial infection,while to cefoperazone sulbactam,amikacin,meropenem,imipenem and linezolid,the drug resistance have lowly drug resistance rate.The resistance rate of cocci infected with end-stage liver disease to penicillin,levofloxacin,ciprofloxacin,erythromycin and gentamicin was higher,while to linezolid,vancomycin,tigecycline and compound sulfamethoxazole,there was lower resistance rate.