乙肝肝硬化失代偿期并发自发性细菌性腹膜炎患者腹水培养病原菌分布及药敏分析  

Component and drug sensitivity test results of pathogenic bacteria in cirrhosis patients with spontaneous bacterial peritonitis

作　　者：于飞 马兴彬 闫晓红[1] 文新平 高金祥[1] YU Fei;MA Xingbin;YAN Xiaohong;WEN Xinping;GAO Jinxiang(Department of General Practice,Binzhou Medical University Hospital,Binzhou 256603,Shandong,P.R.China;Department of Gastroenterology,Binzhou Medical University Hospital,Binzhou 256603,Shandong,P.R.China)

机构地区：[1]滨州医学院附属医院全科医学科,山东滨州256603 [2]滨州医学院附属医院消化内科,山东滨州256603

出　　处：《滨州医学院学报》2023年第3期176-180,184,共6页Journal of Binzhou Medical University

摘　　要：目的回顾性分析乙型肝炎肝硬化失代偿期并发自发性腹膜炎(SBP)患者腹水培养病原菌分布、药敏状况及临床真实抗生素选择应用情况,为合理选择抗菌药物提供参考。方法收集并分析乙型肝炎肝硬化失代偿期并发SBP患者的腹水病原菌培养、药敏试验,并针对抗生素的选择及依据药敏结果的调整应用情况,对6个临床科室30名医师行问卷调查,使用SPSS 26.0行统计学分析。结果49名患者腹水标本中,分离出病原菌60株,41例患者为单一菌感染,8例患者为复合菌感染。其中革兰阴性菌36株、革兰阳性菌22株和真菌2株。革兰阴性菌中主要致病菌以大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌的肠杆菌目为主。药敏结果显示,革兰氏阴性菌对美罗培南、替加环素、哌拉西林/舒巴坦、阿米卡星敏感,对复方新诺明、氨苄西林和氨苄西林/舒巴坦,头孢唑林、妥布霉素、左氧氟沙星耐药率较高。革兰阳性菌中主要致病菌为缓症链球菌、金黄色葡萄球菌、人葡萄球菌。革兰阳性菌对万古霉素、利奈唑胺、氯霉素、利福平敏感,对青霉素、氨苄西林、红霉素耐药率较高。抗菌药物使用情况临床问卷调查显示,医师初期会选择使用广谱抗生素(29/30,96.67%),但在药敏结果回示后,仅有1名会调整为窄谱抗生素(3.3%)。结论乙肝肝硬化失代偿期并发SBP患者腹水培养的病原菌以革兰阴性菌居多,同时混合菌感染比例增加,尤其是低毒力的条件致病菌。在临床实践过程中仍存在抗生素应用不合理情况,应依据药敏结果及时调整抗菌药物,减少耐药菌的产生。Objective To retrospectively analyze the pathogen distribution,drug sensitivity,and clinical antibiotic selection and application of ascites in patients with decompensated hepatitis B cirrhosis complicated with spontaneous peritonitis,so as to provide references for rational selection of antibiotics.Methods Pathogenic bacterial cultures and drug sensitivity tests were collected and analyzed from ascites of patients with decompensated hepatitis B cirrhosis complicated by spontaneous peritonitis.Thirty doctors from six clinical departments were surveyed using a questionnaire based on antibiotic selection and adjustment for drug sensitivity results.SPSS 26.0 was used for statistical analysis.Results Sixty strains of pathogenic bacteria were isolated from 49 ascites samples.Forty-one patients were infected with a single bacterium and eight were infected with a complex bacterium.Thirty-six strains of Gram-negative bacteria,22 strains of Gram-positive bacteria,and two strains of fungi were found.The leading pathogens of Gram-negative bacteria were Escherichia coli,Klebsiella pneumonia,and Enterobacter cloacae.Drug sensitivity results showed that Gram-negative bacteria were sensitive to meropenem,tigecycline,piperacillin/selection,and amikacin,and highly resistant to sulfamethoxazole,ampicillin,ampicillin/sulbactam,cefazolin,tobramycin,and levofloxacin.The leading pathogens of Gram-positive bacteria were Streptococcus aureus,Staphylococcus aureus,and Staphylococcus aureus.Gram-positive bacteria were sensitive to vancomycin,linezolid,chloramphenicol,and rifampicin and were highly resistant to penicillin,ampicillin,and erythromycin.According to the clinical questionnaire survey on the use of antibiotics,doctors would initially choose to use broad-spectrum antibiotics(29/30,96.67%),but only one would adjust to narrow-spectrum antibiotics(3.3%)after the drug sensitivity results are returned.Conclusion Gram-negative bacteria were the most common pathogen in the ascites of patients with decompensated hepatitis B cirrhosis com

关 键 词：乙型肝炎肝硬化失代偿期 自发性腹膜炎 腹水培养 病原菌分布 药敏实验 抗生素应用 

分 类 号：R575.2[医药卫生—消化系统]