乙型肝炎肝硬化失代偿期并发自发性细菌性腹膜炎患者临床分离菌的分布特点及耐药情况分析  

Distribution characteristics and drug resistance analysis of clinically isolated pathogens in patients complicated with decompensated hepatitis B cirrhosis and spontaneous bacterial peritonitis

作　　者：张旺 王国充 张甜 李伯安 ZHANG Wang;WANG Guochong;ZHANG Tian;LI Boan(Department of Clinical Laboratory,the Fifth Medical Center of Chinese PLA General Hospital,Beijing 100039,China;College of Laboratory Medicine,Hebei North University,Zhangjiakou,Hebei 075132,China)

机构地区：[1]中国人民解放军总医院第五医学中心检验科,北京100039 [2]河北北方学院医学检验学院,河北张家口075132

出　　处：《国际检验医学杂志》2022年第19期2346-2351,共6页International Journal of Laboratory Medicine

基　　金：“艾滋病和病毒性肝炎等重大传染病防治”科技重大专项(2020ZX10001002)。

摘　　要：目的 探讨腹腔积液培养阳性乙型肝炎肝硬化失代偿期并发自发性细菌性腹膜炎(SBP)患者临床分离菌的分布特点、感染特点及对常用抗菌药物的耐药情况,为临床预防性用药提供依据。方法 选取2020年1月至2021年12月中国人民解放军总医院第五医学中心收治的腹腔积液培养阳性乙型肝炎肝硬化失代偿期并发SBP患者187例,回顾性分析临床分离菌的分布特点和耐药情况。结果 共检测出220株临床分离菌,主要包括凝固酶阴性葡萄球菌(CoNS)和肠杆菌科细菌,分别占33.18%和26.36%。由单一菌引起感染的病例占85.03%。细菌耐药性方面,90.00%以上的葡萄球菌为产青霉素酶菌株;40.00%的金黄色葡萄球菌和79.45%的CoNS对甲氧西林耐药;CoNS对红霉素的耐药率很高,达65.75%,对左氧氟沙星、克林霉素、复方磺胺甲噁唑和环丙沙星的耐药率较高,均大于30.00%;屎肠球菌对青霉素、氨苄西林、环丙沙星、左氧氟沙星和红霉素有很高的耐药率,耐药率达80.00%及以上;主要革兰阳性球菌对万古霉素、喹奴普汀/达福普汀、替加环素和利奈唑胺的敏感性都很高;有34.48%的肠杆菌科细菌为产超广谱β-内酰胺酶菌株;大肠埃希菌对氨苄西林的耐药率很高,达74.19%,对其他青霉素类,第一、二、三代头孢菌素,喹诺酮类和磺胺类药物有较高的耐药率,耐药率均超过40.00%;肺炎克雷伯菌对哌拉西林表现出很高的耐药率,达61.54%;阴沟肠杆菌对第一、二代头孢菌素有很高的耐药率,达75.00%及以上,对哌拉西林,第三、四代头孢菌素和氨曲南有较高的耐药率,均超过30.00%;主要肠杆菌科细菌对哌拉西林/他唑巴坦复合制剂、碳青霉烯类、氨基糖苷类药物的敏感性均较高;鲍曼不动杆菌均表现出多重耐药性。结论 乙型肝炎肝硬化失代偿期并发SBP主要由单一致病菌感染引起,CoNS和肠杆菌科细菌是主要致病菌,临床分离出肠杆菌科细Objective To investigate the distribution characteristics, infection characteristics and resistance to common antimicrobial drugs in peritoneal effusion culture positive patients complicated with decompensated hepatitis B cirrhosis and spontaneous bacterial peritonitis(SBP),so as to provide the basis for clinical preventive medication.Methods A total of 187 patients with positive ascites culture and decompensated hepatitis B cirrhosis complicated with SBP admitted to the Fifth Medical Center of Chinese PLA General Hospital from January 2020 to December 2021 were enrolled in the study.The distribution characteristics and drug resistance analysis of clinically isolated pathogens were retrospective analysed.Results A total of 220 clinical isolates were detected, mainly including coagulase-negative Staphylococcus(CoNS) and Enterobacteriaceae bacteria, accounting for 33.18% and 26.36% respectively.The infection caused by a single bacterium accounted for 85.03%.Regarding the bacterial drug resistance aspects, more than 90.00% of Staphylococcus were penicillin-producing strains;40.00% Staphylococcus aureus and 79.45% CoNS were resistant to methicillin;CoNS showed a high rate of resistance to erythromycin, up to 65.75%,and the drug resistance rates to levofloxacin, clindamycin, cotrimoxazole, and ciprofloxacin were high(more than 30.00%);Enterococcus faecium had high drug resistance rates to penicillin, ampicillin, ciprofloxacin, levofloxacin, and erythromycin, which were 80.00% and above;the major Gram positive were highly sensitive to vancomycin, quinupretin/dapoputin, tigecycline and linezolid;34.48% of Enterobacteriaceae produced extended Spectyum β lactamase;the resistance rates of Escherichia coli to ampicillin was high(74.19%),and the resistance rates of Escherichia coli to other penicillin, first, second and third generation cephalosporins, quinolones and sulfonamides were high(more than 40.00%).Klebsiella pneumoniae showed high resistance rate to piperacillin(61.54%).Enterobacter cloacae had high resistance rat

关 键 词：乙型肝炎肝硬化 失代偿期 自发性细菌性腹膜炎 细菌学 耐药性 

分 类 号：R446.5[医药卫生—诊断学]