慢性肝病患者胸腹水标本病原菌检测及耐药性分析

Analysis on pathogens and bacterial resistance of pleuroperitoneal fluid in patients with chronic liver disease

目的总结慢性肝病患者胸腹水标本中病原菌种类及其耐药情况。方法对2009年1月至2012年7月慢性肝病患者送检的胸腹水标本进行分离培养、鉴定及药敏试验。结果从2602份胸腹水标本中分离出病原菌392株,阳性检出率为15.1%,其中革兰阴性(G-)菌占44.6%,革兰阳性(G+)菌占52.8%,真菌占2.6%。G-菌中主要为大肠埃希菌(E.coli),占40.0%,其中47.1%为产超广谱β内酰胺酶(ESBL)的E.coli;其次为肺炎克雷伯菌肺炎亚种(18.9%)。G+菌中主要为屎肠球菌(26.6%)和表皮葡萄球菌(17.9%)。E.coli对第三、四代头孢菌素耐药率高(均在40.0%以上),对氨苄西林、环丙沙星、四环素、复方磺胺甲噁唑的耐药率均在60%以上。其中产ESBL的E.coli对亚胺培南、美罗培南敏感,对临床常用的其他抗菌药物耐药率均在60%以上。屎肠球菌对利奈唑酮、替考拉宁、万古霉素的耐药率较低,分别为3.6%、5.5%、5.5%。结论 E.coli占慢性肝病患者胸腹水感染病原菌的第1位,其次是屎肠球菌。产ESBL的E.coli对大多数抗菌药物均耐药,但对亚胺培南、美罗培南敏感。屎肠球菌对头孢西丁、克林霉素、苯唑西林等均耐药,但对利奈唑酮、替考拉宁、万古霉素敏感。

Objective To summarize the kinds of pathogens and bacterial resistance of pleuroperitoneal fluid spec- imens in patients with chronic liver disease. Methods The pleuroperitoneal fluid specimens were collected from patients with chronic liver disease from January, 2009 to July, 2012. The specimens were cultured, strain identification and drug sensitive test were carried out. Results The total quantity of specimens were 2 602, 392 pathogenic bacteria were isolat- ed, the positive rate was 15.1%. Gram-negative bacteria accounted for 44.6%, Gram-positive bacteria accounted for 52.8%, fungi accounted for 2.6%. Among the Gram-negative bacteria, Escbericbia coli （E.coli） ranked first （40.0%）, moreover ESBL-producing E. coli accounted for 47.1%, Klebsiella pncumoniae ranked second （18.9%）, the other Gram-negative bacteria accounted for a small amount. Among the Gram-positive bacteria, Enterococcus faecium ranked first （26.6%）, and the Staphylococcus epidermidis ranked second. The resistance rates to the third and forth generation cephabsporins were 〉 40.0%, and the resistance rates to ampicillin, ciprofloxacin, tetracycline and sulfamethoxa- zole-trimethoprim were all 〉60.0%, especially the ESBL-producing E. coli almost resisted to all drugs which were com- monly used clinically. The resistance rate in Enterocoecus faecium which accounted for most part of the Gram-positive bacteria to linezolid, teicoplanin and vaneomycin were 3.6%,5.5%,5.5% respectively. Conclusion E.coli is the first rank in all the strains isolated from pleuroperitoneal fluid of patients with chronic liver disease, Enterococcus faecium is the sec- ond. Enterococcus faecium is susceptible to linezolid, teicoplanin and vancomyein, ESBL-produeing E.coli is susceptibleto imipenem and meropenem.