乙肝肝硬化患者伴发细菌性腹膜炎的病原菌分布特点及其耐药性与危险因素分析  

Distribution and antibiotic resistance of pathogens in hepatitis B-related liver cirrhosis patients with spontaneous bacterial peritonitis and analysis of associated risk factors

作　　者：李圆圆 田慧 和振坤 LI Yuanyuan;TIAN Hui;ZHEN Kun(Department of Infectious Diseases,Huaihe Hospital,Henai University,Kaifeng 475000,Henan,China)

机构地区：[1]河南大学淮河医院感染科,河南开封475000

出　　处：《中国病原生物学杂志》2025年第5期628-632,共5页Journal of Pathogen Biology

摘　　要：目的探讨乙肝肝硬化患者伴发自发性细菌性腹膜炎(SBP)的病原菌分布特点及其耐药性,分析相关危险因素,为临床防治提供科学依据。方法选取2021年1月至2023年12月在本院住院的肝硬化伴腹水患者,共198例,所有患者符合肝硬化的国际诊断标准,并根据腹水白细胞中性粒细胞计数及培养结果分为SBP组(122例)和无SBP组(76例)。收集患者的临床特征和实验室检查数据,包括性别、年龄、腹水蛋白水平、Child-Pugh评分、既往SBP病史、肝功能和肾功能等指标。通过单因素分析筛选与SBP发生显著相关的变量,并将P<0.05的变量纳入多因素Logistic回归模型,分析独立危险因素。同时,分析SBP组病原菌分布及其耐药性,依据CLSI(Clinical and Laboratory Standards Institute)标准评估抗生素敏感性和耐药性。结果在SBP组122例患者中,共分离病原菌112株,阳性率为91.80%。革兰阴性菌为主要病原菌,占59.82%(67/112),其中大肠埃希菌和肺炎克雷伯菌分别占(41.96%,47/112)和(15.18%,17/112)。革兰阳性菌占36.61%(41/112),以肠球菌(21.43%,24/112)和金黄色葡萄球菌(7.14%,8/112)为主。厌氧菌占3.57%(4/112),主要为梭状芽孢杆菌。对112株病原菌的药敏试验显示,革兰阴性菌对三代头孢和喹诺酮类抗生素耐药率较高,其中大肠埃希菌和肺炎克雷伯菌的耐药率分别为42.55%和35.29%。不动杆菌属对碳青霉烯类的耐药率为40.00%。革兰阳性菌中,肠球菌对万古霉素的耐药率为12.50%,金黄色葡萄球菌对甲氧西林的耐药率为25.00%。多重耐药菌(MDR)的检出率为31.25%,以革兰阴性菌为主(37.31%)。多因素Logistic回归分析表明,腹水蛋白<1.0 g/dL(OR=2.72,95%CI:1.54-4.83,P<0.001)、Child-Pugh评分C级(OR=2.41,95%CI:1.29-4.52,P=0.006)、CRP(OR=1.09,95%CI:1.04-1.14,P<0.001)和SCr(OR=1.03,95%CI:1.01-1.06,P=0.012)为SBP发生的独立危险因素。结论乙肝肝硬化伴发细菌性腹膜炎的主要病原菌为革兰阴性菌,尤Objective To investigate the distribution and antibiotic resistance of pathogens in patients with hepatitis B-related liver cirrhosis complicated by spontaneous bacterial peritonitis(SBP),and to analyze associated risk factors,providing evidence for clinical prevention and treatment.Methods A total of 198 cirrhotic patients with ascites hospitalized at our institution between January 2021 and December 2023 were included.All patients met the international diagnostic criteria for liver cirrhosis and were divided into the SBP group(122 patients)and the non-SBP group(76 patients)based on the neutrophil count in ascitic fluid and culture results.Clinical characteristics and laboratory data,including sex,age,ascitic fluid protein levels,Child-Pugh score,history of SBP,liver function,and renal function,were collected.Univariate analysis was used to identify variables significantly associated with SBP(P<0.05),which were then included in a multivariate logistic regression model to determine independent risk factors.The distribution and antibiotic resistance of pathogens in the SBP group were analyzed,and antimicrobial susceptibility testing was performed following the Clinical and Laboratory Standards Institute(CLSI)guidelines.Results Among 122 patients in the SBP group,112 pathogenic strains were isolated,with a positivity rate of 91.80%.Gram-negative bacteria accounted for 59.82%(67/112),primarily Escherichia coli(41.96%,47/112)and Klebsiella pneumoniae(15.18%,17/112).Gram-positive bacteria constituted 36.61%(41/112),predominantly Enterococcus spp.(21.43%,24/112)and Staphylococcus aureus(7.14%,8/112).Anaerobic bacteria made up 3.57%(4/112),mainly Clostridium spp.Antibiotic susceptibility testing revealed high resistance rates of Gram-negative bacteria to third-generation cephalosporins and quinolones,with E.coli and K.pneumoniae showing resistance rates of 42.55% and 35.29%,respectively.Acinetobacter spp.demonstrated a resistance rate of 40.00% to carbapenems.Among Gram-positive bacteria,Enterococcus spp.showed a vancom

关 键 词：乙肝肝硬化 细菌性腹膜炎 病原菌分布 耐药性 危险因素 

分 类 号：R575.2[医药卫生—消化系统]