3年自发性细菌性腹膜炎病原菌及耐药性的回顾性分析

Bacterial epidemiology and antimicrobial resistance in spontaneous bacterial peritonitis:a 3-year retrospective study

目的探讨终末期肝病合并自发性细菌性腹膜炎(SBP)的病原菌分布特点及细菌耐药趋势。方法对医院2007年1月-2009年12月住院的肝病合并SBP患者腹水病原菌及药敏试验结果进行分析。结果在腹水细菌培养阳性的64例标本中,革兰阴性菌36株,占56.3%,革兰阳性菌28株,占43.7%,从2007-2009年革兰阳性菌呈逐年递增的趋势;革兰阴性菌对含β-内酰胺酶抑制剂的抗菌药物耐药率较低;革兰阳性菌对万古霉素、呋西地酸较敏感,对青霉素、苯唑西林、庆大霉素、红霉素的敏感性均较低。结论 SBP感染的细菌谱在不断变化的,目前革兰阳性菌引起的SBP日益多见;产β-内酰胺酶的革兰阴性菌和耐甲氧西林葡萄球菌的大量出现给临床治疗带来了困难;因此,迫切需要通过监测SBP的细菌流行病学特征,更合理地选择经验性治疗的抗菌药物。

OBJECTIVE To evaluate the bacterial epidemiology and antimicrobial resistance of the patients of end stage liver disease combined with spontaneous bacterial peritonitis （SBP）. METHODS The results of pathogenic bacteria and antibiotic susceptibility test of ascitic fluids from hospitalized liver disease patients with SBP were analyzed retrospectively between Jan 2007 and Dec 2009. RESULTS Among the 64 ascitic specimens, Gram- negative bacteria accounted for 36 （56. 3%） and gram-positive bacteria 28 （43. 7%）. From 2007 to 2009 the proportion of gram-positive bacteria were increasing. 59 ascitic isolates antibiotic susceptibility test results showed Gram-negative bacteria showed lower resistance to the compound preparation containing beta-lactamase inhibitors. The susceptibility rate of Gram-positive bacteria to vaneomycin and fusidin was comparatively high, and that to penicillins, oxacillin, gentamiein and erythrocin was lower. CONCLUSION The current bacterial spectrum of SBP is changing, and there is an increasing incidence of Gram-positive bacteria as a cause of SBP during recent years. The emergence of Gram-negative bacteria with producing beta-lactamase and methicillin-resistant staphylococcus bring diffieulties to clinical treatment. Thus, monitoring the epidemiologieal characteristics bacteria of SBP to determine the efficacy of empirical antibiotic treatment in SBP are required.