肝硬化腹水患者并发自发性细菌性腹膜炎病原菌与影响因素分析  

Analysis of pathogenic bacteria and factors affecting spontaneous bacterial peritonitis in patients with cirrhosis ascites

作　　者：谭志洁[1] 赵静 刘文兴 刘珊珊 王玲玲 TAN Zhi-jie;ZHAO Jing;LIU Wen-xing;LIU Shan-shan;WANG Ling-ling(Shizhong District People's Hospital of Ji'nan,Ji'nan,Shandong 250022,China)

机构地区：[1]济南市市中区人民医院消化内科

出　　处：《中华医院感染学杂志》2019年第19期2953-2956,共4页Chinese Journal of Nosocomiology

基　　金：山东省自然科学基金资助项目(201603415)

摘　　要：目的分析肝硬化腹水患者并发自发性细菌性腹膜炎的病原菌特点,探讨引发细菌性腹膜炎的影响因素,为临床治疗提供参考意见。方法回顾性分析2015年1月-2017年12月济南市市中区人民医院收治的肝硬化腹水患者122例的临床资料,根据病理标本的检验结果,分析发生自发性细菌性腹膜炎肝硬化腹水患者的病原菌特点,分析肝硬化腹水并发自发性细菌性腹膜炎患者性别、年龄、腹水蛋白的资料,归纳肝硬化腹水患者并发自发性细菌性腹膜炎的影响因素。结果122例肝硬化腹水患者并发自发性细菌性腹膜炎26例,共培养分离病原菌31株,其中革兰阴性菌19株占61.29%,革兰阳性菌12株占38.71%,以肺炎克雷伯菌、链球菌和大肠埃希菌为主;肺炎克雷伯菌对哌拉西林、氨苄西林耐药率较高,而对亚胺培南、哌拉西林/他唑巴坦、阿米卡星较敏感;大肠埃希菌对头孢曲松、氨苄西林、头孢替坦、氨曲南耐药率较高,而对磺胺甲噁唑/甲氧苄啶、左氧氟沙星、阿米卡星较敏感;肺炎链球菌对红霉素、庆大霉素耐药性较高,而对左氧氟沙星、青霉素、头孢吡肟较敏感。Child-Pugh评分、总胆红素水平是肝硬化腹水患者并发自发性细菌性腹膜炎的影响因素(P<0.05)。自发性腹膜炎患者经对症治疗后,腹痛、腹泻、发热症状均缓解,复查腹水常规、腹水培养,未见异常。结论临床医师应全面评估患者病情,及时进行干预,以降低自发性腹膜炎发生率。OBJECTIVE To analyze the characteristics of pathogenic bacteria of spontaneous bacterial peritonitis in patients with cirrhosis ascites,and to explore the influencing factors of bacterial peritonitis,so as to provide reference for clinical treatment.METHODS The clinical data of 122 patients with cirrhosis ascites admitted to the Shizhong District People’s Hospital of Ji’nan from Jan.2015 to Dec.2017 were retrospectively analyzed.The pathological specimens were analyzed for the pathogens characteristics of patients with spontaneous bacterial peritonitis and cirrhosis.The gender,age and ascites protein of patients with spontaneous bacterial peritonitis and ascites due to cirrhosis were analyzed,and the influencing factors of spontaneous bacterial peritonitis in patients with cirrhosis and ascites were summarized.RESULTS In the 122 patients with cirrhosis ascites,26 cases of spontaneous bacterial peritonitis occurred,and 31 strains of pathogenic bacteria were isolated and cultured,among which 19 strains of Gram-negative bacteria accounted for 61.29%,and 12 strains of Gram-positive bacteria accounted for 38.71%,with Klebsiella pneumoniae,Streptococcus and Escherichia coli as the main pathogens.K.pneumoniae showed relatively high resistance to piperacillin and ampicillin,but was more sensitive to imipenem,piperacillin/tazobactam,and amikacin.E.coli showed relatively high resistance to ceftriaxone,ampicillin,cefotetan,and aztreonam,but was more sensitive to sulfamethoxazole/trimethoprim,levofloxacin,and amikacin.S.pneumoniae showed relatively high resistance to erythromycin and gentamicin,but was more sensitive to levofloxacin,penicillin and cefepime.Child-Pugh score and total bilirubin level were the influencing factors of spontaneous bacterial peritonitis in patients with cirrhosis ascites(P<0.05).After symptomatic treatment of patients with spontaneous peritonitis,abdominal pain,diarrhea,and fever were all relieved,and routine ascites and ascites culture were reviewed.No abnormalities were observed.CONCLUSION Th

关 键 词：肝硬化腹水 自发性细菌性腹膜炎 病原菌 影响因素 

分 类 号：R657.31[医药卫生—外科学]