肝硬化患者腹腔感染的病原菌分布与耐药性分析  

Distribution and drug resistance of pathogens causing abdominal infections in patients with liver cirrhosis

作　　者：崔宏 高琴琴[3,4] 杨楠木 贺涛[1,2] 万百顺 王效谦[1,2] 黄涛 张玲[1,2] 韩风 

机构地区：[1]郑州大学附属肿瘤医院肝胆胰腺外科,河南郑州450052 [2]河南省肿瘤医院肝胆胰腺外科,河南郑州450052 [3]郑州大学附属人民医院消毒供应室,河南郑州450052 [4]河南省人民医院消毒供应室,河南郑州450052

出　　处：《中华医院感染学杂志》2018年第1期40-43,共4页Chinese Journal of Nosocomiology

基　　金：河南省医学科技攻关计划基金资助项目(201303010)

摘　　要：目的分析肝硬化患者失代偿期并发腹腔感染的病原菌分布及其耐药性,为合理使用抗菌药物提供参考依据。方法选取2014年10月-2017年2月医院收治的肝硬化失代偿期并发腹腔感染患者320例为研究对象,腹腔穿刺术后留取患者腹水标本进行细菌鉴定和药敏试验。结果 320例患者中病原菌培养阳性83例,阳性率为25.94%;腹水培养阳性患者共检出病原菌136株,其中革兰阴性菌89株占65.44%;革兰阳性菌43株占31.62%;真菌4株占2.94%;主要革兰阴性菌为大肠埃希菌、肺炎克雷伯菌及铜绿假单胞菌,其中大肠埃希菌对碳青霉烯类抗菌药物(亚胺培南、美罗培南等)及半合成青霉素与β-内酰胺酶抑制剂合成制剂(哌拉西林/他唑巴坦)耐药率为0,肺炎克雷伯菌对β-内酰胺类抗菌药物普遍耐药,尤其是阿莫西林,其耐药率达100.00%,而对碳青霉烯类抗菌药物(亚胺培南等)耐药率为0,铜绿假单胞菌对亚胺培南及阿米卡星耐药率为0;主要革兰阳性菌为表皮葡萄球菌与肺炎链球菌,两者均对青霉素产生耐药,耐药率达100.00%;表皮葡萄球菌对万古霉素、替考拉宁及阿米卡星耐药率为0;肺炎链球菌仅对万古霉素及替考拉宁耐药率为0。结论肝硬化患者腹腔感染病原菌主要为革兰阴性菌,且以大肠埃希菌和肺炎克雷伯菌为主,并对亚胺培南、美罗培南均敏感,可作为临床首选用药;而对三、四代头孢菌素的耐药率有上升趋势,临床应根据具体药敏结果进行治疗。OBJECTIVE To investigate the distribution and drug resistance of pathogens causing abdominal infec- tions in patients with decompensated liver cirrhosis so as to provide guidance for reasonable use of antibiotics. METHODS A total of 320 decompensated liver cirrhosis patients complicated with abdominal infections who were treated in hospitals from Oct 2014 to Feb 2017 were recruited as the study objects.The ascites specimens were col- lected from the patients after abdominal paracentesis, the isolated pathogens were identified, and the drug suscep- tibility testing was performed.RESULTS Among the a20 patients, 83 were positive for culture of pathogens, with the positive rate 25.94%.Totally 136 strains of pathogens were isolated from the patients who were positive for culture of ascites, of which 89 （65.44%） were gram-negative bacteria, 43 （31.62%） were gram-positive bacteria, and 4 （2.94%） were fungi; the Escherichia coli, Klebsiella pneurnoniae and Pseudomonas aeruginosa were dom- inant among the gram-negative bacteria, and the drug resistance rates of the E.coli strains to carbapenems （imi- penem, meropenem） and semi-synthetic penicillin as well as β-1actamase inhibitor preparations （piperacillin- tazobactam） were 0; the K.pneumoniae strains were generally resistant to β-lactams, the drug resistance rate toamoxacillin was as high as 100.00%, however, the drug resistance rate to carbapenems （imipenem） was O; the drug resistance rates of the P.aeruginosa strains to imipenem and amikacin were O.The Staphylococcus epidermi- dis and Streptococcus pneumoniae were the predominant species of the gram-positive bacteria, the drug resistance rate of the two species to penicillin was as high as 100.00%, the drug resistance rates of the S.epidermidis strains to vancomycin, teicoplanin and amikacin were O, and the drug resistance rates of the S.pneumoniae strains to van- comycin and teicoplanin were O.CONCLUSION The gram-negative bacteria are dominant among the pathogens cau- sing the abdominal infec

关 键 词：肝硬化失代偿期 腹腔感染 病原菌分布 耐药性 

分 类 号：R657.31[医药卫生—外科学]