肝硬化患者自发性腹膜炎腹水病原菌及耐药性分析

Distribution and drug resistance of pathogens isolated from ascites of liver cirrhosis patients complicated with spontaneous bacterial peritonitis

目的探讨肝硬化合并自发性腹膜炎(SBP)患者腹水病原菌的分布及耐药性,为临床治疗选择敏感性抗菌药物提供依据。方法回顾性分析2008年4月-2012年2月住院治疗70例肝硬化合并SBP且腹水细菌培养阳性患者的临床资料,分析其腹水细菌培养和药物敏感试验结果。结果 70例患者腹水中共分离出72株病原菌,革兰阴性菌51株占70.8%,革兰阳性菌18株占25.0%,真菌3株占4.2%,其中产ESBLs大肠埃希菌6株占24.0%,产ESBLs肺炎克雷伯菌1株占11.1%;对革兰阴性菌耐药性较高的是头孢类及喹诺酮类抗菌药物,对革兰阳性菌耐药性较高的是氨苄西林和哌拉西林。结论肝硬化合并SBP患者中腹水病原菌以革兰阴性菌为主,耐药现象严重,应根据药物敏感试验报告合理选用抗菌药物,从而达到有效抗菌目的,并抑制或延缓耐药菌株的出现。

OBJECTIVE To explore the distribution and drug resistance of pathogens isolated from ascites of the liver cirrhosis patients complicated with spontaneous bacterial peritonitis （SBP） so as to provide basis for clinical treatment with sensitive antibiotics. METHODS Totally 70 cases of liver cirrhosis complicated with SBP, who were hospitalized from Apr 2008 to Feb 2012, were enrolled in the study, then the clinical data of the subjects whose ascites were cultured positive were retrospectively analyzed, and the results of the culture of ascites and the drug susceptibility testing were analyzed. RESULTS Among the 70 patients, a total of 72 strains of pathogens have been isolated, including 51 （70.8%） strains of gram-negative bacteria, 18 （25. 0%）strains of gram-positive bacteria, and 3 （4. 2 %） strains of fungi; there were 6 （24. 0 %） strains of ESBLs-producing Escherichia coli and 1 （11.1%） strain of ESBLs-producing Klebsiella pneumoniae. The gram-negative bacteria were highly resistant to cephalosporins and quinolones; the gram-positive bacteria were highly resistant to ampicillin and piperacillin. CONCLUSION The gram-negative bacteria are dominant among the pathogens isolated from the ascites of the liver cirrhosis patients complicated with SBP and are highly drug-resistant; it is necessary to reasonably use antibiotics based on the drug susceptibility testing report so as to effectively inhibit the pathogens and postpone the occurrence of drug-resistant strains.