간경변증에 합병된 균혈증의 임상적 고찰 = A Clinical Review of Bacteremia in Patients with Liver Cirrhosis간경변증에 합병된 균혈증의 임상적 고찰

다국어 초록 (Multilingual Abstract)

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다국어 초록 (Multilingual Abstract)

In a nine-year retrospective study, there were S5 episodes (2.24%) of bacteremia among 3789 patients with liver cirrhosis. The total number of causative microorganisms was 87 strains. The mean patient age was 49.6±10.5 years. Of 85 patients, 69 were male and 16 were female giving a ratio of approximately 4.3 to 1. The peak of highest age incidence was the fourth and fifth decades. Community acquired bacteremia numbered 59 episodes and hospital acquired, 26 episodes. In hospital acquired bacteremia, twenty patients (76.9%) underwent one or more major procedures such as gastroscopy, endoscopic sclerotherapy, balloon tamponade, paracentesis, or intraabdominal surgery just before the onset of bacteremia. The causative microorganisms were 72 strains of gram-negative bacteria (82.8%) and 15 strains of gram-positive bacteria (17.2%). Of the more common microorganisms, E. coli accounted for 37.9 percent, Klebsiella 16.1 percent and Staphylococcus 14.9 percent. The incidence of Staphylococcus was relatively high in community acquired bacteremia, and Klebsiella was high in hospital acquired bacteremia. In community acquired bacteremia, E, coli were highly susceptible to aminoglycoside, cefamandole and third generation cephalosporin. Klebsiella were susceptible to aminoglycoside and second and third generation cephalosporin. Staphylococcus were highly susceptible to cephalothin, methicillin and clindamycin. In hospital acquired bacteremia, E. coli were highly susceptible to aminoglycoside and third generation cephalosporin, Klebsiella to aminoglycoside, cephalosporin and chloramphenicol, and Staphylococcus were susceptible to cephalothin, but 50% were susceptible to methicillin, clindamycin, erythromycin and chloramphenicol. Of 85 bacteremic patients with liver cirrhosis, 31 patients (36.5%) died; in community acquired bacteremia, 23 patients (37.7%) died and in hospital acquired bacteremia, 8 patients (30.8%) died. The causes of death were sepsis and/or septic shock, bleeding, hepatic coma, etc. The severity of the cirrhosis was assessed according to Child's grading; 2 patients were found to be in claw A (2.4/c ), 12 in class B (14,1%), and 71 in class C (83.5%), Seventy-three patients suffered from one or more of the following complications: ascites, encephalopathy, hematemesis, and spontaneous bacterial peritonitis. Two or more (mean 2.2) complications were associated with mortality eases, whereas approximately one (mean 1.3) complication was seen in improved patients. In conclusion, patients suffering from liver cirrhosis were highly susceptible to infection because of various defects in the defence system, and when bacteremia developed, the prognosis was very poor. Therefore, bacteremia should be considered a serious complication in liver cirrhosis.