自发细菌性腹膜炎病原菌变化及药敏分析

Pathogen changes and drug susceptibility analysis of spontaneous bacterial peritonitis

目的探讨自发细菌性腹膜炎致病菌的变化及病原菌对抗菌药物敏感性的变化,为临床治疗提供依据。方法对2002年7月-2012年6月住院的肝硬化并发自发细菌性腹膜炎患者送检的腹水标本分离培养的病原菌及药物敏感测定的数据进行回顾性分析,并分成2002-2007年及2007-2012年两个阶段,对上述结果用SPASS 10.0软件进行分析。结果两个阶段共分离培养出病原菌94株,均以大肠埃希菌为主,分别为19株和34株,各占51.4%和59.6%,其次为肺炎克雷伯菌,分别为8株和11株,各占21.6%和19.3%,粪肠球菌占第3位,均分离出6株,分别占16.2%和10.5%,其他菌株有变形菌属、链球菌属、铜绿假单胞菌以及真菌;2007-2012年病原菌对哌拉西林、头孢菌素类以及喹诺酮类耐药率较2002-2007年阶段明显升高,差异有统计学意义(P<0.05)。结论 10年来肝硬化并发自发细菌性腹膜炎的主要致病菌谱未发生明显变化,但由于产超广谱β-内酰酶(ESBLs)大肠埃希菌及肺炎克雷伯菌明显增加,耐药率也呈上升趋势。

OBJECTIVE To observe and analyze the changes of bacteria spectrum and antibiotics sensitivity in spon- taneous bacterial peritonitis （SBP）, and provide the basis for clinical therapy. METHODS Clinical distribution and drug resistance of bacterial strains isolated from ascites samples of patients with hepatic cirrhosis complicated with SBP during Jul. 2002 to Jun. 2012 in our hospital , were retrospective analysis and artificially divided into 2002-- 2007 and 2007--2012 two stages, the data were analyzed by SPASS 10.0 software. RESULTS A total of 94 strains of bacteria were isolated, Escherichia coli was the most common pathogen in the two stages, respectively 19 and 34 strains, accounting for 54.3% and 60.7% respectively, followed by Klebsiella pneumoniae, respectively 8 and 11 strains, accounting for 22. 9% and 19. 6% respectively, Enterococcus faecalis occupied third, all 6 strains, accounting for 17.10% and 10.7% respectively, there were other strains of Proteus, Streptococcus, Pseudomonas aeruginosa and fungi, but the proportion was very small. Bacterial resistance, 2007--2012 stage of piperacillin, cephalosporins and quinolone resistance increased significantly from 2002--2002 stage （P〈0.05）. CONCLUSION In recent 10 years, spectrum has not significantly changed the main pathogenic bacteria of hepatic cirrhotic patients with SBP, but due to extended-spectrum β-1actamase （ESBLs） positive Escherichia coli and K. pneumonia signifi- cantly increase, drug resistance rate is rising.