108例肝硬化腹水合并自发性细菌性腹膜炎患者腹水病原菌及其耐药性分析

Pathogenic Bacteria and its Drug Resistance in Cirrhotic Ascites Complicated with Spontaneous Bacterial Peritonitis: Clinical Analysis of 108 Cases

背景:自发性细菌性腹膜炎(SBP)是肝硬化腹水患者的常见严重并发症,临床治疗效果欠佳。目的:探讨肝硬化腹水合并SBP患者腹水病原菌的分布及其耐药情况,为临床合理选用抗生素提供指导。方法:对108例次腹水细菌培养阳性肝硬化腹水合并SBP患者的临床资料以及腹水细菌培养和药物敏感试验结果进行回顾性分析。结果:108例次腹水细菌培养阳性肝硬化腹水合并SBP患者中,共分离出病原菌206株,其中革兰阴性菌占68.9%(142株),革兰阳性菌占31.1%(64株)。分离菌株的耐药情况比较严重,治疗前单类耐药和多重耐药比例分别为50.9%和27.8%,治疗后多重耐药的比例显著高于治疗前(73.8%对27.8%,P<0.01)。结论:对肝硬化腹水合并SBP患者,应根据药物敏感试验报告合理选用抗生素,从而达到有效抗菌目的,并抑制或延缓耐药菌株的出现。

Background： Spontaneous bacterial peritonitis （SBP） is one of the most severe complications of cirrhotic patients, and the therapeutic effects of the antibiotics are unsatisfactory. Aims： To appraise the ascitic bacterial categories and its drug resistance in cirrhotic patients complicated with SBP, so as to provide the guideline for use of antibiotics. Methods： The clinical data, the results of bacterial culture and drug sensitivity tests of 108 ascitic specimens from cirrhotic patients with SBP were analyzed retrospectively. Results： From the 108 ascitic specimens, 206 bacterial strains were isolated. Among them, gram-negative bacteria constituted 68.9% （142 strains） and gram-positive bacteria 31.1% （64 strains）. The isolated strains were highly resistant to antibiotics, the incidence of mono-drug and multi-drug resistance were 50.9% and 27.8%, respectively. The incidence of multi-drug resistance increased after antibiotics treatment （73.8% vs. 27.8%, P〈 0.01）. Conclusions： In cirrhotic ascites complicated with SBP, reasonable use of antibiotics is necessary according to the drug sensitivity test to achieve the therapeutic effect and to delay the emergence of resistant strains.