肝硬化患者腹水培养的病原菌分布与耐药性分析  

Pathogen Distribution and Drug-resistance in Ascites of Patients with Liver Cirrhosis

作　　者：朱明利[1] 李超丹[1] 厉小玉[1] 周俊[1] 章松平[1] 潘熠健[1] 

机构地区：[1]杭州市第六人民医院微生物室,浙江杭州310014

出　　处：《中华医院感染学杂志》2010年第8期1180-1182,共3页Chinese Journal of Nosocomiology

摘　　要：目的了解肝硬化合并自发性细菌性腹膜炎（SBP）患者腹水培养中病原菌的分布特点及耐药情况,为临床合理用药提供依据。方法回顾性分析医院2005年1月-2008年7月诊断为肝硬化合并SBP患者腹水细菌培养阳性的结果。结果细菌培养阳性病例为123例,共分离出病原菌130株,114例患者为单菌感染（22.68%）,19例患者血和腹水培养出相同的细菌;130株细菌中革兰阴性菌64株（49.23%）,列第1、2位的分别是大肠埃希菌和肺炎克雷伯菌,革兰阳性菌51株（39.23%）,真菌14株（10.77%）,抗酸杆菌1株（0.77%）;本结果显示,革兰阴性菌对亚胺培南、阿米卡星、哌拉西林/他唑巴坦、呋喃妥因、头孢西丁耐药率较低,分别是7.81%、4.69%、7.81%、4.69%、7.81%,革兰阳性菌对庆大霉素、利福平、四环素耐药率较低,分别是3.92%、9.80%、7.84%,暂未发现对万古霉素耐药的菌株。结论改善肝硬化患者预后的关键在于积极预防SBP,对可疑合并SBP者应及早行腹腔穿刺做腹水检查,以便及早做出诊断。OBJECTIVE To understand the bacterial distribution and drug resistance in ascites of cirrhosis patients with spontaneous bacterial peritonitis（SBP）,and to provide a basis for clinical rational drug use.METHODS The positive culture results for the diagnosis of SBP in patients with cirrhosis ascites from January 2005 to Jul 2008 in our hospital were retrospectively analyzed.RESULTS From 123 cases with positive cultures,130 strains of bacteria were isolated.Among them,114 patients with single infection（accounted for 92.68%）,19 cases with the same bacterial culture of blood and ascites.Of 64 strains（49.23%）of Gram-negative bacteria,Escherichia coli and Klebsiella pneumoniaewere the main.Gram-positive bacteria（G＋） were 51 strains（39.23%）,fungi were 14（10.77%）,and acid-fast bacilli accounted for 0.77%（1 strain）.Antimicrobial susceptibility test（AST） showed that for G-bacteria,drug resistance to imipenem,amikacin,piperacillin/tazobactam,nitrofurantoin and cefoxitin was relatively low with 7.81%,4.69%,7.81%,4.69% and 7.81%,respectively.The resistance of G＋ bacteria to gentamicin,rifampicin and tetracycline were relatively low（with 3.92%,9.80% and 7.84% respectively）,and vancomycin-resistant strain was not found.CONCLUSIONS The key to improve the prognosis of patients with cirrhosis is to prevent SBP.In order to make a diagnosis earlier for patients with suspicious SBP,the peritoneal ascites puncture examination should be done as soon as possible.

关 键 词：腹水 肝硬化 细菌培养 耐药性 

分 类 号：R378[医药卫生—病原生物学]