肝硬化合并自发性细菌性腹膜炎的病原学研究

pathogens of spontaneous bacterial peritonitis in patients with liver cirrhosis

目的 探讨肝硬化合并自发性细菌性腹膜炎(sbp)医院感染和社区感染病原菌的分布特点及耐药情况.方法 收集肝硬化合并sbp且腹水培养阳性的住院患者84例,将其分为社区感染组61例(72.6%)和医院感染组23例(27.4%),回顾性分析患者的临床资料,鉴定细菌并作药敏试验.采用spss 16.0软件进行统计学分析.结果 84株细菌中革兰阴性菌68株(81.0%),革兰阳性菌16株(19.0%).大肠埃希菌和肺炎克雷伯菌为主要致病菌,在社区感染组中分别占34.4%(21/61)和24.6%(15/61),在医院感染组中分别占52.2%(12/23)和26.1%(6/23),两组感染率差异无统计学意义(x2=2.21和0.02,p值均>0.05).药敏试验结果显示大肠埃希菌和肺炎克雷伯菌对亚胺培南的敏感性均达100%,对哌拉西林/他唑巴坦的敏感性也较高,但对氨苄西林和氨苄两林/舒巴坦的耐药率较高.esbls+菌对头孢菌素的耐药率达100%,而esbls-菌对头孢菌素完全敏感.结论 肝硬化合并sbp感染以革兰阴性菌为主,其中大肠埃希菌和肺炎克雷伯菌为主要致病菌,产esbls菌对头孢菌素类药物耐药率显著增加,临床上应引起重视并合理选用抗菌药物. abstract： objective to investigate the pathogens and their antibiotic resistance profile of hospital and community-acquired spontaneous bacterial peritonitis ( sbp) in patients with liver cirrhosis. methods eighty-four cirrhotic patients with sbp were recruited, in which 61 (72. 6% ) were diagnosed as communityacquired sbp and 23 (27.4% ) were diagnosed as hospital-acquired sbp. bacterial identification and drug susceptibility tests were performed. spss 16. 0 was used for statistical analysis. results there were 68 (81.0%) gram-negative strains and 16 (19.0%) gram-positive strains. escherichia coli and klebsiella pneumoniae were the top two prevalent strains. in community-acquired group, there were 21 (21/61, 34. 4% ) strains of escherichia coli and 15 ( 15/61 , 24. 6% ) strains of klebsiella pneumoniae; while in hospital-acquired group, it was 12 (12/23, 52.2%) strains and 6 (6/23, 26. 1%) strains, respectively. there were no statistical differences in the infection rates of escherichia coli and klebsiella pneumoniae between community and hospital-acquired sbp patients (x2 = 2. 21 and 0. 02, p > 0. 05). drug susceptibility tests showed that escherichia coli and klebsiella pneumoniae were 100% sensitive to impenem, and the sensitivity to piperacillin/tazobactam was also high. but these strains were highly resistant to ampicillin and ampicillin/sulbactam. all extended spectrum β-lactamases ( esbls) positive strains were resistant to cephalosporins, while esbls-negative strains were all sensitive to cephalosporins. conclusions sbp in patients with liver cirrhosis are mainly caused by gram-negative strains, especially escherichia coli and klebsiella pneumoniae. esbls-positive strains are highly resistant to cephalosporins, so proper use of right antibacterial agents is important.

Objective To investigate the pathogens and their antibiotic resistance profile of hospital and community-acquired spontaneous bacterial peritonitis ( SBP) in patients with liver cirrhosis. Methods Eighty-four cirrhotic patients with SBP were recruited, in which 61 (72. 6% ) were diagnosed as communityacquired SBP and 23 (27.4% ) were diagnosed as hospital-acquired SBP. Bacterial identification and drug susceptibility tests were performed. SPSS 16. 0 was used for statistical analysis. Results There were 68 (81.0%) Gram-negative strains and 16 (19.0%) Gram-positive strains. Escherichia coli and Klebsiella pneumoniae were the top two prevalent strains. In community-acquired group, there were 21 (21/61, 34. 4% ) strains of Escherichia coli and 15 ( 15/61 , 24. 6% ) strains of Klebsiella pneumoniae; while in hospital-acquired group, it was 12 (12/23, 52.2%) strains and 6 (6/23, 26. 1%) strains, respectively. There were no statistical differences in the infection rates of Escherichia coli and Klebsiella pneumoniae between community and hospital-acquired SBP patients (x2 = 2. 21 and 0. 02, P > 0. 05). Drug susceptibility tests showed that Escherichia coli and Klebsiella pneumoniae were 100% sensitive to impenem, and the sensitivity to Piperacillin/Tazobactam was also high. But these strains were highly resistant to Ampicillin and Ampicillin/Sulbactam. All extended spectrum β-lactamases ( ESBLs) positive strains were resistant to cephalosporins, while ESBLs-negative strains were all sensitive to cephalosporins. Conclusions SBP in patients with liver cirrhosis are mainly caused by Gram-negative strains, especially Escherichia coli and Klebsiella pneumoniae. ESBLs-positive strains are highly resistant to cephalosporins, so proper use of right antibacterial agents is important.