失代偿期乙型肝炎肝硬化腹腔积液病原菌分布特点及其耐药情况调查  

Distribution and drug resistance of pathogens in patients with decompensated hepatitis B cirrhosis and spontaneous bacterial peritonitis

作　　者：丁蓉 姬文莉 陈婷婷[1] 张倩 吴梦秋 Ding Rong;Ji Wenli;Chen Tingting(Medical Laboratory,Tongren Hospital Affiliated to Southeast University School of Medicine,Nanjing 211102,Jiangsu Province,China)

机构地区：[1]东南大学医学院附属南京同仁医院医学检验科,南京市211102

出　　处：《实用肝脏病杂志》2024年第3期398-401,共4页Journal of Practical Hepatology

基　　金：南京同仁医院院长科研基金资助项目(编号:2022E009)。

摘　　要：目的调查失代偿期乙型肝炎肝硬化患者腹腔感染的病原菌分布特点及耐药情况。方法2019年1月~2023年1月我院收治的559例失代偿期乙型肝炎肝硬化患者,取腹水培养,采用VITEK-2 Compact全自动微生物鉴定系统鉴定细菌种类和药敏试验。结果在559例肝硬化患者中,腹水培养病原菌阳性119例(21.3%)119株,其中革兰阴性杆菌74株(62.2%),革兰阳性球菌35株(29.4%)和酵母样真菌10株(8.4%);大肠埃希菌对氨苄西林耐药性为97.1%,对环丙沙星和一、二、三代头孢菌素类耐药性也大于40.0%,而对阿米卡星和厄他培南敏感,肺炎克雷伯菌对氨苄西林耐药性为100.0%,对其他抗生素耐药性均低于30.0%,阴沟肠杆菌对头孢菌素类耐药性均大于30.0%,而对阿米卡星、庆大霉素和厄他培南敏感;凝固酶阴性葡萄球菌、金黄色葡萄球菌和屎肠球菌均对青霉素的耐药性大于80.0%,而对万古霉素、替加环素和利奈唑胺敏感;酵母样真菌对常用抗真菌药物均敏感。结论失代偿期乙型肝炎肝硬化腹腔感染的病原菌以革兰阴性杆菌为主,耐药现象普遍存在,临床治疗需早期行腹水培养,选择敏感抗生素积极治疗,预后尚好。Objective The aim of this study was to investigate the distribution and drug resistance of pathogens in patients with decompensated hepatitis B liver cirrhosis(LC)and spontaneous bacterial peritonitis(SBP).Methods A series of 559 patients with decompensated hepatitis B-induced LC were admitted to our hospital between January 2019 and January 2023,and the ascites were obtained for routine bacterial culture.The bacterial characterization and drug susceptibility were conducted by VITEK-2 compact automatic microbial identification system.Results Among the 559 patients with decompensated LC,the ascites bacterial culture was positive in 119 cases(21.3%),including 74 strains(62.2%)of Gram-negative bacteria,35 strains(29.4%)of Gram-positive bacteria and 10 strains(8.4%)of fungi infection;the Escherichia Coli was resistant to ampicillin up to 97.1%,the resistance to ciprofloxacin and first-generation,second-generation and third-generation cephalosporins greater than 40.0%,and was sensitive to amicacin and ertapenem;the Klebsiella Pneumoniae was resistant to ampicillin up to 100.0%,while sensitive to other commonly administered antibiotics;the Enterobacter Cloacae was resistant to cephalosporins greater than 30.0%,but sensitive to amikacin,gentamicin and ertapenem;the coagulase-negative Staphylococcus,Staphylococcus Aureus and Enterococcus Faecium was resistant to penicillin greater than 80.0%,but sensitive to vancomycin,tigacycline and linezolid;the Fungi we found were all sensitive to common antifungal agents.Conclusion The main pathogens in patients with SBP are Gram-negative bacteria in our hospital,and the drug resistance is common.In clinical practice,the early ascites culture and bacterial characterization are necessary for sensitive antibiotics selection.

关 键 词：肝硬化 腹腔积液 感染 病原菌 耐药 

分 类 号：R446.5[医药卫生—诊断学] R512.62[医药卫生—临床医学] R575.2