肝硬化并发自发性腹膜炎腹水的病原菌及大肠埃希菌耐药性分析

Pathogens and Escherichia coli drug resistance in liver cirrhosis patients complicated with spontaneous bacterial peritonitis

目的探讨肝硬化合并自发性细菌性腹膜炎(spontaneous bacterial peritonitis,SBP)病原菌分布及大肠埃希菌耐药情况,为临床诊断和治疗SBP提供可靠的依据。方法对浙江省绍兴市第六人民医院2006年1月至2010年12月诊断为肝硬化合并SBP者,进行腹水病原菌分离鉴定和药敏试验。结果 115例腹水患者中分离出18种115株病原菌,以大肠埃希菌的检出率最高,54株占47.0%,其中产超广谱β-内酰胺酶(extended-spectrumβ-lactamase,ESBLs)19株占35.2%,对碳青霉烯类抗菌药物均敏感,对β-内酰胺类药物耐药性有增高趋势。结论诊断SBP除应尽早进行腹水细菌培养外,还应结合临床症状,依据药敏结果合理选用抗菌药物。

Objective To understand the distribution of pathogens and the drug resistance of Escherichia coli in liver cirrhosis patients complicated with spontaneous bacterial peritonitis （SBP） and provide evidence for the clinical diagnosis and treatment of SBP. Methods Totally 115 hospitalized liver cirrhosis patients complicated with SBP in our hospital from January 2006 to December 2010 were selected to conduct pathogen isolation from ascites samples and drug susceptibility test of pathogens isolated. Results Totally 115 strains of 18 pathogens were isolated from the patients＇ ascites samples. The detection rate of E. coli was highest （47. 0% ）, and 19 strains of E. coli were ESBLs producing （35.2%）. E. coli was sensitive to carbapenems antibiotics, but the resistance to β-1actam antibiotics showed an increase trend. Conclusion The diagnosis of SBP should depend on both pathogen isolation result and clinical symptoms. Antibiotics should be used according to the result of drug susceptibility test.