肝硬化患者自发性肠球菌性腹膜炎的临床特征  

Clinical characteristics of spontaneous enterococcal peritonitis in patients with cirrhosis

作　　者：陈铭[1] 丁秀荣[1] 于艳华[1] 康艳芳[1] 王晨[1] 娄金丽[1] Chen Ming;Ding Xiurong;Yu Yanhua;Kang Yanfang;Wang Chen;Lou Jinli(Clinical Laboratory Center,Beijing Youan.Hospital,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京佑安医院临床检验中心,北京100069

出　　处：《北京医学》2021年第9期890-893,共4页Beijing Medical Journal

摘　　要：目的总结肝硬化并发自发性肠球菌性腹膜炎(spontaneous enterococcal peritonitis,SEP)患者的临床特征、病原学特点和相关危险因素。方法回顾性分析2013年1月至2018年12月首都医科大学附属北京佑安医院395例肝硬化并发自发性腹膜炎(spontaneous peritonitis,SP)患者的临床资料,比较SEP与其他病原体所致SP的差异,并对SEP发生的危险因素进行分析。结果395例SP患者中SEP 72例,分离出的72株肠球菌,对万古霉素的耐药率为19.4%(14/72),粪肠球菌对氨苄西林(94.4%比10.4%)、呋喃妥因(94.4%比14.6%)、环丙沙星(55.6%比10.4%)敏感率高于屎肠球菌,差异有统计学意义(P<0.001)。单因素与多因素logistic回归分析均显示,与肠球菌性腹膜炎相关的危险因素包括医院感染[OR值(95%CI):3.254(1.011~10.473),P=0.048]、糖尿病[OR值(95%CI):2.038(1.049~3.958),P=0.036]和近期抗菌药物治疗[OR值(95%CI):5.505(1.348~22.484),P=0.018]。结论SEP在SP的构成比有增高趋势,且SEP的耐药情况不容乐观,屎肠球菌比粪肠球菌具有更高的耐药性;肝硬化患者发生SEP的危险因素包括医院感染、糖尿病和近期抗菌药物治疗。Objective To summarize the clinical characteristics,microbiological features and the risk factors in cirrhotic patients with spontaneous enterococcal peritonitis(SEP).Methods The clinical data of 395 cirrhotic patients with spontaneous peritonitis(SP)were retrospectively analyzed.The differences between the patients with SEP and with other SP were compared,and the risk factors of SEP were analyzed.Results Seventy-two SEP cases(18.2%)were identified from 395 cases with SP in Beijing Youan Hospital from January 2013 to December 2018.Among those SEP patients,the total vancomycin-resistance rate was 19.4%(14/72).The susceptibility rate of Enterococcus faecalis to ampicillin(94.4%vs.10.4%),furantoin(94.4%vs.14.6%)and ciprofloxacin(55.6%vs.10.4%)was higher than that of Enterococcus faecium,the difference was significant(P<0.001).Univariate and multivariate analysis revealed that the independent risk factors of SEP were nosocomial infection[OR(95%CI):3.254(1.011-10.473),P=0.048],diabetes mellitus[OR(95%CI):2.038(1.049-3.958),P=0.036]and recent antibiotic treatment[OR(95%CI):5.505(1.348-22.484),P=0.018].Conclusions The composition ratio of SEP in SP tends to increase,the drug resistance of SEP is not optimistic.The resistance of Enterococcus faecium is higher than that of Enterococcus faecalis.Nosocomial infection,diabetes mellitus,and recent antibiotic therapy are risk factors for SEP in the patients with cirrhosis.

关 键 词：肝硬化 肠球菌 自发性细菌性腹膜炎 临床特征 危险因素 

分 类 号：R575.2[医药卫生—消化系统] R572.2[医药卫生—内科学]