肝硬化并自发性细菌性腹膜炎患者腹水培养的病原菌分布及耐药性分析

Analysis of pathogen distribution and drug resistance in liver cirrhosis patient with spontaneous bacterial peritonitis

目的探讨自发性细菌性腹膜炎患者腹水病原菌特点及耐药,为临床合理用药提供依据。方法回顾性分析医院诊断为肝硬化并自发性细菌性腹膜炎(534例)患者的腹水细菌培养阳性结果,依据不同感染菌将患者进行分组,比较各组内细菌所占百分比,同时针对优势菌株(大肠埃希菌、屎肠球菌)进行耐药率分析。结果细菌培养阳性病例为61例,占总病例数的11.42%,共分离出病原菌78株,45例患者为单菌感染(73.8%),16例患者为复合菌感染(26.2%),其中15例为两种菌感染,占复合细菌感染的93.8%;78株细菌中革兰阴性菌40株(51.3%),其中以大肠埃希菌为主,占革兰阴性菌的37.5%;革兰阳性菌32株(41.0%),其中以屎肠球菌为主,占革兰阳性菌的59.38%,且屎肠球菌总菌株数(19株)高于大肠埃希菌(15株);真菌6株,占总菌株数的7.7%;大肠埃希菌对氨苄西林、左氧氟沙星、复方新诺明及头孢呋辛耐药率较高,分别是93.3%、80.0%、73.3%;对亚胺培南、阿米卡星耐药率较低,均为6.7%;未见对厄他培南、美洛西林的耐药菌株。屎肠球菌对氨苄西林、青霉素、左氧氟沙星、诺氟沙星耐药率较高,分别是68.4%、63.2%、57.9%、42.1%;发现对万古霉素耐药的1例菌株,为屎肠球菌;未发现对利奈唑胺耐药的菌株。结论肝硬化并发自发性细菌性腹膜炎患者腹水细菌感染以屎肠球菌和大肠埃希菌为主,耐药严重,临床应依据感染病原菌的类型和药敏合理选择抗生素。

Objective To analyze pathogen distribution and drug resistance in liver cirrhosis patients with spontaneous bacterial peritonitis for the basis for clinical rational drug use.Methods Retrospective analysis was made in the positive bacterial culture results of liver cirrhosis patients（534cases）with spontaneous bacterial peritonitis in our hospital.Depending on the kind of bacteria,we grouped the patients,and compared the percentage of each group of bacteria,at the same time for the dominant strains（Escherichia coli,Enterococcus feces）,we analyzed resistance rate.Results Bacterial culture positive cases was 61 cases and 78 strains of pathogenic bacteria were isolated,in which 45 patients as a single infection（73.8%）,16 patients a composite infection（26.2%）and 15 cases of complex infection（93.8%）.In 78 strains of bacteria,gram-negative bacteria were 40strains（51.3%）,and Escherichia coli accounted for37.5% of gram-negative bacteria;gram-positive bacteria was 32（41.0%）,of which Enterococcus Faecium accounted for59.4% of gram-negative bacteria,meanwhile the total number of Enterococcus Faecium（19）was more than Escherichia coli（15）;Fungi was 6strains,accounting for 7.7%.E.coli was highly resistant to ampicillin and levofloxacin,trimethoprim-sulfamethoxazole,cefuroxime,respectively,accounted for 93.3%,80.0% and 73.3%.Enterococcus Faecium was highly resistant to Feces enterococci to ampicillin,penicillin,levofloxacin,norfloxacin,respectively,68.4%,63.2%,57.9% and 42.1%;Discovery of one case of vancomycin-resistant strains was Enterococcus Faecium.No strains resistant to linezolid were discovered.Conclusion In liver cirrhosis patients with spontaneous bacterial peritonitis infected mainly in Enterococcus Faecium and Escherichia coli,the phenomenon of resistance has been very serious.Clinicians should be based on the type of pathogen and make reasonable choice for antibiotic use.