肝硬化患者腹水感染致病菌菌谱变化与药敏分析

Bacterial spectrum changes and analysis of antibiotic sensitivity in ascitic infection patients with hepatic cirrhosis

目的:探讨肝硬化腹水感染致病菌变化及细菌对抗生素敏感性的变化.方法:对处于Child-Pugh分级B、C阶段肝硬化腹水感染患者临床数据进行回顾性分析.结果:两个阶段的主要致病菌仍是革兰氏阴性杆菌,两个时期,致病菌仍以大肠杆菌为主,分别占45.8%和60.3%.但1997-2000年的大肠杆菌药敏中庆大霉素敏感率达88.9%、丁胺卡那霉素敏感率达91.1%、氨苄青敏感性达44.4%,2001-2004年中分别下降到35.2%、39.8%、26.1%.2001-2004年大肠杆菌对头孢类敏感性达81.8%以上.近年来菌谱及其耐药性发生变化,厌氧菌和真菌感染呈上升趋势.结论:针对肝硬化腹水,预防性应用抗生素,为了避免耐药菌的产生,应依据腹水培养和药敏试验结果,从而提高临床疗效.

AIM： To observe and analyze the changes of bacterial spectrum and antibiotic sensitivity in ascitic infection patients with liver cirrhosis. METHODS： The clinical data of ascitic infection patients with liver cirrhosis at Child-Pugh stage B and C were analyzed retrospectively and comparatively. RESULTS： The gram-negative bacilli covered the largest percentage in the patients at ChildPugh stage B and C, and colon bacteria were the most common pathogenic factors, the percentages of which were 45.8% and 60.3%, respectively. The sensitivities of gentamycin, amikacin, and ampicillin to colon bacteria were 88.9%, 91.1% and 44.4%, respectively, during the period from the year 1997 to 2000, and those decreased to 35.2%, 39.8%, and 26.1%, respectively, during the period from the year 2001 to 2004. The sensitivity of cephalosporin to colon bacteria was 81.8% during the period of 2001 to 2004. However, the infections of fungicides and anaerobes were found increasing from 2001 to 2004. CONCLUSION： Preventive adoption of antibiotics in the treatment of ascitic infection patients with liver cirrhosis must be based on the results of bacterium culture and antibiotic sensitivity test.