肝硬化合并自发性细菌性腹膜炎的病原学和耐药情况  

Antimicrobial resistance of bacteria isolated from cirrhotic patients with spontaneous bacterial peritonitis

作　　者：魏丽荣[1] 刘景院[1] 宋丽红[1] 

机构地区：[1]首都医科大学附属北京地坛医院,北京100015

出　　处：《中华实验和临床感染病杂志（电子版）》2013年第3期71-74,共4页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

摘　　要：目的监测肝硬化合并自发性细菌性腹膜炎的病原学和耐药情况。方法回顾性分析首都医科大学附属北京地坛医院2010年1月至2011年12月诊断为肝硬化自发性腹膜炎的送检腹水标本共452例,统计分析病原谱的分布和抗菌药物的敏感性。结果收集腹水标本中分离到的94株致病菌,培养阳性率为20.8%(94/452)。其中革兰阴性杆菌49株(52%),革兰阳性球菌42株(45%),真菌3株(3%)。病原菌以肠道来源细菌占优势,革兰阴性杆菌以肠杆菌科为主,其中大肠埃希菌19株(20%)、肺炎克雷伯菌6株(6%),革兰阳性球菌中以肠球菌和凝固酶阴性葡萄球菌检出率最高,其中凝固酶阴性葡萄球菌12株(13%)、屎肠球菌10株(11%)和粪肠球菌8株(9%)。3株真菌均为白念珠菌。革兰阴性杆菌敏感率在80%以上的抗菌药物有阿米卡星(93%,40/43)、亚胺培南(81.4%,35/43)和美罗培南(83.7%,36/43),敏感率在60%以上的有头孢他啶(62.8%,27/43)和哌拉西林/他唑巴坦(68.2%,15/22)。对革兰阳性球菌敏感率在80%以上的有万古霉素(96.9%,30/31)、替考拉宁(89.7%,26/29)、利奈唑胺(87.9%,29/33)和奎奴普丁/达福普汀(100%,18/18),敏感率在60%以上的有复方新诺明(70%,21/30)和甲氧苄胺(76.5%,13/17)。结论肝硬化自发性细菌性腹膜炎的病原体以肠源性细菌多见,主要为大肠埃希菌和肠球菌,分离株对常见抗菌药物明显耐药。Objective To investigate the distribution and antibiotic resistance of bacteria isolated from ascites in liver cirrhosis patients with spontaneous peritonitis. Methods Total of 452 cases with cirrhosis and spontaneous peritonitis in our hospital between 2010 and 2011 were collected and the distribution of pathogens spectrum and antimicrobial susceptibility of bacteria isolated from their ascites specimens were analyzed, retrospectively. Results Total of 94 strains were isolated among 452 ascites specimens, with the cultivate positive rate as 20.8%. Among which, 49 strains were Gram-negative bacilli （52%, 49/94）, 42 strains of Gram-positive cocci （45%, 42/94） and 3 strains of fungi （3%, 3/94）. The most common isolates were enterogenous bacteria, and enterobacteriaceae bacteria was the major Gram negative bacilli, including 19 strains ofE. coli （20%, 19/94） and 6 strains of Pneumonia crayresearch （6%, 6/94）, the most commonly isolated Gram positive cocci included Coagulase-negative Staphylococci （13%, 12/94）, Feces enterococci （11%, 10/94） and Enterococcusfaecalis （9%, 8/94）, and all 3 isolates of fungi were Candida albicans. Antibiotics wtih the susceptibilities to these Gramnegative bacilli over 80% included amikacin （93%, 41/43）, imipenem （81.4%, 35/43） and meropenem （83.7%, 36/43）, with ceftazidime （62.8%, 27/43） and piperacillin/tazobactam （68.2%, 15/22） higher than 60%. For Grampositive cocci, the susceptibility higher than 80% included vancomycin （96.9%, 30/31）, teicoplanin（89.7%, 26/29）, linezolid （87.9%, 29/33） andquinupristin/dalfopristin （100%, 18/18）, with cotrimoxazole （70%, 21/30） and trimethoprim （76.5%, 13/17） higher than 60%. Conclusions Enterogenous bacteria is the major cause to spontaneous bacterial peritonitis in cirrhotic patients, particularly E. coli and Enterococei, and isolated bacteria are resistant to common antibiotics, which should be paid close attention to.

关 键 词：细菌耐药 肝硬化 腹膜炎 自发性 细菌性 

分 类 号：R446.5[医药卫生—诊断学]