Abstract: Objective To investigate the distribution and drug resistance analysis of pathogenic bacteria in abdominal infection after liver resection, transarterial chemoembolization（TACE） and liver transplantation in primary liver cancerpatients. Methods The clinical data of 158 primary liver cancer patients with abdominal infection after liver resection, TACE or liver transplantation in our hospital from Jan 2018 to May 2023 were retrospectively analyzed, to investigate their pathogenic bacteria distribution and drug resistance. Results From samples of patients with abdominal infection after liver resection, TACE, and liver transplantation, 204, 69, and 34 strains of pathogenic bacteria were cultured, respectively. Gram-negative bacteria accounted for 51.96%, 62.32% and 52.94%; Gram-positive bacteria for 40.20%, 30.43%, and 32.35%; and fungi for 7.84%, 7.25%, 14.71%, respectively. The most common pathogenic bacteria were Escherichia coli（14.71%）, Escherichia coli（18.84%） and Klebsiella pneumoniae（11.76%） among primary liver cancer patients with abdominal infection after liver resection, TACE and liver transplantation. According to the results of drug susceptibility, Escherichia coli and Klebsiella pneumoniae had a high rate of resistance to Cephalosporins, Quinolones and Sulfonamides. Among Escherichia coli and Klebsiella pneumoniae, the detection rate of strains producing extended-spectrum beta-lactamases （ESBLs） were 56.8% and 27.8% and meanwhile, the detection rate of strains with carbapenem resistance were 2.3% and 16.2%. Conclusion Among the primary liver cancer patients with abdominal infection after liver resection, TACE or liver transplantation, the main pathogenic bacteria is enterobacteriaceae and the multi-drug resistance strains have a high rate of detection. While choosing the postoperative prophylactic antibiotics, the antibiotics which are effective to the enterobacteriaceae are the first choice.

Key words: primary liver cancer, liver resection, transarterial chemoembolization, liver transplantation, abdominal infection, pathogenic bacteria, drug resistance

摘要： 目的 探讨原发性肝癌患者肝切除、肝动脉化疗栓塞（TACE）以及肝移植术后腹腔感染的病原菌分布和耐药性。方法 回顾性分析2018年1月至2023年5月中山大学孙逸仙纪念医院158例原发性肝癌患者行肝切除术、TACE或肝移植术后发生腹腔感染的临床资料,分析腹腔感染的病原菌和耐药性。结果 肝切除术后、TACE和肝移植术后腹腔感染的患者标本分别培养得到204株、69株和34株病原菌,革兰氏阴性菌分别占51.96%、62.32%和52.94%,革兰氏阳性菌分别占40.20%、30.43%和32.35%,真菌分别占7.84%、7.25%和14.71%,最常见的病原菌分别是大肠埃希菌（14.71%）、大肠埃希菌（18.84%）和肺炎克雷伯菌（11.76%）。药敏试验显示,大肠埃希菌和肺炎克雷伯菌对头孢菌素、氟喹诺酮类以及磺胺类抗菌药物耐药率均较高。大肠埃希菌和肺炎克雷伯菌的超广谱β-内酰胺酶（ESBLs）阳性率分别为56.8%、27.8%,耐碳青霉烯肠杆菌科细菌（CRE）检出率分别为2.3%、16.2%。结论 原发性肝癌患者肝切除、TACE以及肝移植术后腹腔感染的病原菌主要为肠杆菌科细菌,多重耐药菌的检出率较高,术后预防性用药可首选覆盖肠杆菌科的抗菌药物。

关键词: 原发性肝癌, 肝切除术, 肝动脉化疗栓塞, 肝移植, 腹腔感染, 病原菌, 耐药性