肝病并发自发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 patients of liver disease complicated with spontaneous bacterial peritonitis

目的探讨肝病合并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参考。方法对53例腹水细菌培养阳性的肝病合并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。结果在腹水细菌培养阳性的53例标本中,革兰阴性菌占69.8%(37/53),革兰阳性菌占22.6%(12/53)。对革兰阴性菌较敏感的是亚胺培南、阿米卡星及哌拉西林/三唑巴坦,其他如庆大霉素、头孢三代及喹诺酮类的敏感率均较低;对革兰阳性菌较敏感的是万古霉素及利奈唑胺,其他如青霉素类、头孢类及喹诺酮类的敏感率均较低。结论对肝病合并SBP患者,腹水病原菌以革兰阴性菌为主,耐药现象比较严重。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。

Aim To appraise the ascitic bacterial categories and its drug resistance in patients of liver disease complicated with SBP, so as to provide the reference for use of antibiotics. Methods The clinical data, the results of bacterial culture and drug sensitivity tests of 53 ascitic specimens from patients of liver disease complicated with SBP were analyzed retrospectively. Results Among the 53 ascitic specimens, gram-negative bacteria accounted for 69.8% （37/53） and gram-positive bacteria 22.6% （12/53）. The result of drug sensitiv- ity test indicated that susceptibility rate of gram-negative bacteria to imipenem, amikacin and piperacillin/tazobactam was comparatively high, and that to gentamicin, third-generation cephalosporins and quinolones was lower, and the susceptibility rate of gram-positive bacte- ria to vancomycin and linezolid was comparatively high, and that to penicitlins, cephalosporins and quinolones was lower. Conclusion In patients of liver disease complicated with SBP, the main proportion of pathogenic bacteria was gram-negative bacteria, the isolated strains highly resistant to antibiotics. 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.