终末期肝病合并感染诊治专家共识（2021年版）

中华肝脏病杂志2022年2月第30卷第2期Chin J Hepatol,.February2022,Vol.30,No.2·147指南与共识·终末期肝病合并感染诊治专家共识（2021年版)中华医学会感染病学分会通信作者：宁琴，华中科技大学同济医学院附属同济医院感染科，武汉430030，Emil:qning(@vip.sina.com王贵强，北京大学第一医院感染疾病科，北京100034，Email:john131212@sina.com【摘要】终末期肝病(SLD)发生和发展中，感染可以诱发或加重ESLD肝功能失代偿的发生，亦是ESLD发展过程中最易出现的并发症之一。ESLD合并感染的规范诊疗需求迫切，2018年7月，中华医学会感染病学分会制订了我国第一部《终末期肝病合并感染诊治专家共识》，基于2018年至今的循证医学数据及治疗方案，进行本次修订。本共识旨在指导并提高临床医务工作者对ESLD合并感染疾病的综合诊治能力。【关键词】终末期肝病；感染；诊断；治疗：共识D0L:10.3760/cma.j.cm501113-20220209-00061Expert consensus on diagnosis and treatment of end-stage liver disease complicated infection (2021 version)Chinese Society of Infectious Diseases,Chinese Medical AssociationCorresponding author:Ning Oin,Department of Infectious Diseases,Tongji Hospital,Tongji Medical CollegeHuazhong University of Science and Technology,Wu Han 430030,China,Email:gning@vip.sina.comCo-corresponding author:Wang Guigiang.Department of Infectious Diseases,Peking University First Hospital.Beijing 100034.China.Email:john131212@sina.com[Abstract]End-stage liver disease (ESLD)is a life-threatening clinical syndrome with significantlyincreased mortality when the patients are complicated with infections.For patients with ESLD,infections caninduce or aggravate the liver decompensation.In turn,infections are among the most common complication with thedisease progression.Experts from Society of Infectious Diseases,Chinese Medical Association firstly formulated"Expert Consensus on Diagnosis and Treatment of End-Stage Liver Disease Complicated with Infection"in July2018,which is extensively revised based on clinical evidence of recent three years.This consensus summarizesthe up-to-date knowledge and experiences across Chinese colleagues,intending to provide principles and wordingprocedures for clinicians to diagnose and treat ESLD patient complicated with infections.[Key words]End-stage liver disease;Infection;Diagnosis;Treatment;ConsensusD0L:10.3760/cma.j.cm501113-20220209-00061终末期肝病(end stage of liver disease,ESLD)于《终末期肝病合并感染诊治专家共识》的基础上，修订了本20世纪80年代提出，至今仍无严格定义。结合肝脏形共识，旨在指导并提高临床医务工作者对SLD合并细菌态和功能，ESLD指各种慢性肝脏损害所致的肝病晚期阶真菌感染疾病的综合诊治能力。段，主要特征为肝脏功能不能满足人体的生理需求。其范畴一、ESLD合并感染的流行病学包括各种慢性肝病的终末期阶段，包括慢加急性肝功能衰竭ESLD合并感染的类型包括腹腔感染、呼吸道感染、泌(acute-om-chronic liver failure,ACLF)、肝硬化急性失代尿道感染、血流感染、胆道感染、胃肠道感染以及皮肤偿(acute decompensation of liver cirrhosis,ADC)、慢软组织感染等，局部感染均可发展为血流感染。ESLD性肝功能衰竭(chronic liver failure,CLF)和肝细胞癌。合并感染以自发性细菌性腹膜炎(spontaneous bacteria感染可以诱发或加重ESLD,也是ESLD最常见的并发症之peritonitis,SBP)最多见，肺部感染次之，病原体以细菌和一，临床诊治棘手。中华医学会感染病学分会联合我国真菌为主（表1）切。相关领域知名专家参照国内外最新研究成果，在2018年版因ESLD患者经常使用抗菌药物，发生院内感染的耐药