肝硬化并发自发性细菌性腹膜炎腹水病原菌变迁及耐药性分析  

Analysis of changes and drug resistance of pathogenic bacteria in ascites of patients with liver cirrhosis complicated with spontaneous bacterial peritonitis

作　　者：刘娟 胡国信[3] LIU Juan;HU Guoxin(Shantou University Medical College,Shantou 515041,China;Department of Hepatology,Huizhou Central People’s Hospital,Huizhou 516000;Department of Infectious Disease,Peking University Shenzhen Hospital,Shenzhen 518036,China)

机构地区：[1]汕头大学医学院,广东汕头515041 [2]惠州市中心人民医院肝病科,广东惠州516000 [3]北京大学深圳医院感染科,广东深圳518036

出　　处：《汕头大学医学院学报》2019年第3期157-160,共4页Journal of Shantou University Medical College

摘　　要：目的:探讨肝硬化并发自发性细菌性腹膜炎腹水培养的病原菌分布及耐药情况。方法:选取2009年3月至2018年10月惠州市中心人民医院90例肝硬化并发自发性细菌性腹膜炎且腹水病原菌培养结果阳性的患者为研究对象,进行腹水病原菌鉴定及药敏试验。结果:肝硬化并发自发性细菌性腹膜炎腹水病原菌以革兰阴性菌为主52株(55.3%),革兰阳性菌35株(37.2%),真菌7株(7.4%)。革兰阴性菌主要为大肠埃希菌(25.5%)和肺炎克雷伯杆菌(9.7%);革兰阳性菌主要为凝固酶阴性葡萄球菌(12.8%)。按时间分组,和前5年组相比,后5年组革兰阳性菌的构成比增加,差异有统计学意义(P<0.05)。药敏试验结果显示,大肠埃希菌对氨苄西林、左氧氟沙星的耐药率高,对亚胺培南、哌拉西林/他唑巴坦、阿米卡星的耐药率低;而葡萄球菌对利奈唑胺、万古霉素的耐药率低。结论:肝硬化并发自发性细菌性腹膜炎患者腹水培养的病原菌以革兰阴性菌居多,但近5年革兰阳性菌构成比有增加的趋势。临床应根据腹水细菌培养和药敏试验结果,合理选用抗菌药物。Objective:To investigate the distribution and drug resistance of pathogenic bacteria in cultured ascites of patients with cirrhosis complicated by spontaneous bacterial peritonitis.Methods:90 patients with cirrhosis complicated by spontaneous bacterial peritonitis and positive results of ascites pathogenic bacteria culture in Huizhou Central People’s Hospital from March 2009 to October 2018 were selected as the subjects for the identification and drug sensitivity test of ascites pathogenic bacteria.Results:Among the ascites pathogens of cirrhosis complicated with spontaneous bacterial peritonitis,52 strains(55.3%)were gramnegative bacteria,35 strains(37.2%)were Gram-positive bacteria and 7 strains(7.4%)were fungi.Gramnegative bacteria were mainly Escherichia coli(25.5%)and Klebsiella pneumoniae(9.7%).Coagulase-negative staphylococci were the main Gram-positive bacteria(12.8%).Grouped by time,the proportion of Grampositive bacteria in the latter five years group increased compared with the former five years group,and the difference was statistically significant(P<0.05).Drug susceptibility test showed that E.coli had high resistance to ampicillin and levofloxacin,but low resistance to imipenem,piperacillin/tazobactam and amikacin,while Staphylococcus had low resistance to linezolid and vancomycin.Conclusion:Gram-negative bacteria were the most common pathogenic bacteria in ascites of patients with cirrhosis complicated with spontaneous bacterial peritonitis,but there was an increasing trend of Gram-positive bacteria in recent five years.In clinic,antibiotics should be rationally selected according to the results of ascites bacterial culture and susceptibility test.

关 键 词：肝硬化 自发性细菌性腹膜炎 病原菌 耐药 

分 类 号：R378[医药卫生—病原生物学]