肝硬化患者自发性气单胞菌性腹膜炎的临床特点和药敏分析

Clinical characteristic and antifungal drug sensitivity of hepatic cirrhosis patients complicating spontaneous Aeromonas bacterial peritomtis

目的探讨肝硬化并发自发性气单胞菌性腹膜炎患者的临床特点和对抗菌药物的敏感性。方法对2001至2010年我院31例肝硬化并发自发性气单胞菌性腹膜炎患者（观察组）与同期62例肝硬化并发其他病原体引起的自发性细菌性腹膜炎患者（对照组）根据年龄、性别分布进行1：2配对的病例一对照研究，同时对观察组分离的气单胞菌进行药敏试验。结果31例观察组患者中，29例（93．5％）为嗜水气单胞菌感染，2例（6．5％）由温和气单胞菌感染。两组患者Child—Pugll分级差异无统计学意义（X2=1．452，P〉0．05）。观察组在4—9月的感染率明显高于对照组，且差异有统计学意义（X2=22．024，P〈0．01）。观察组患者腹泻发生率明显高于对照组（X2=10．908，P〈0．01）。气单胞菌对亚胺培南及哌拉西林／他唑巴坦的耐药率分别为54．8％和41．4％，对阿米卡星、头孢吡肟、环丙沙星、庆大霉素及妥布霉素的敏感性均超过90．0％。在观察组中感染性休克是患者院内死亡的独立危险预测因子（β=4．768，RR=4．25，P〈0．01）。结论在夏、秋季肝硬化并发自发性细菌性腹膜炎患者有腹泻表现时应考虑到气单胞菌可能为病原菌，尤其要注意对感染性休克的防治。Ⅳ代头孢菌素、氨基糖苷类及氟喹诺酮类是目前治疗气单胞菌感染的首选抗菌药物。

Objective To study the clinical features and the sensitivity to antibacterials of hepatic cirrhosis patients complicating spontaneous bacterial peritonitis （SBP） caused by Aeromonas. Methods A retrospective, matched by age and sex case-control study （1：2 ratio） were carried out from 2001 to 2010. Case group included 31 hepatic cirrhosis patients complicating SBP caused by Aeromonas and control group included 62 hepatic cirrhosis patients complicating SBP caused by other organisms. Antimicrobial susceptibility test of Aeromonas isolated form case group was also conducted. Results In case group 29 patients （93.5 % ） infected Aeromonas hydrophila and 2 patients （6.5 % ） infected Aeromonas sorbia. There was no difference of baseline Child-Pugh class between case and control groups（ X2 = 1.452, P 〉 0.05）. Compared with control group, the infection rate during April-September period and the incidence rate of case group was significantly higher （X2 = 22.024 and X2 = 10.908, P all 〈 0.01）. The drug resistance rates of Aeromonas to imipenem and piperacillin/tazobactmn were 54.8% and 41.4%, respectively. The sensitive rates of Aeromonas to amikacin, cefepime, ciprofloxacin, gentamicin and tobramycin were all over 90.0%. In case group septic shock was the independent risk predictor of in-hospital mortality （β=-4.768, RR = 4.25, P 〈 0.01）. Conclusions Aeromonas species should be considered to be a causative organism of SBP in hepatic cirrhosis patients presenting with diarrheal episodes during the warm season, it is needed to pay particular attention to the prevention and treatment of septic shock. The antibacterial drugs, such as fourth-generation cephalosporins, aminoglyeosides and fluoroquinolones are the first choice to remedy Aeromonas infectious presently.