乙型肝炎肝硬化并发自发性腹膜炎患者腹水培养病原菌分布及药敏分析

Pathogen distribution and drug resistance in hepatitis B cirrhosis patients combined with spontaneous bacterial peritonitis

目的回顾性分析乙型肝炎肝硬化失代偿期并发自发性腹膜炎(SBP)患者腹水培养病原菌分布及药敏状况,为临床一线抗生素合理利用提供参考。方法收集并分析该院SBP腹水培养阳性患者45例(其中1例培养出2株细菌,共计46株细菌)的临床资料。结果 46株细菌分布为革兰阴性菌(G^-)占69.6%和革兰阳性菌(G^+)占30.4%。G^-以大肠埃希菌和肺炎克雷伯菌为主,分别为41.3%和17.4%,其中产ESBLs细菌达到51.9%。G^+以血浆凝固酶阴性菌为主,占57.1%。药敏结果,G^-对亚胺培南均敏感;G^+对替加环素、万古霉素均敏感。结论乙型肝炎肝硬化失代偿期并发SBP患者腹水培养病原菌G^-占优势,并以大肠埃希菌及肺炎克雷伯肠源性细菌为主,临床应根据药敏试验结果正确选择抗生素。

Objective To retrospectively analyze the pathogen distribution and drug resistance in hepatitis B cirrhosis patients combined with spontaneous bacterial peritonitis( SBP) and to provide reference for rational use of antibiotics in clinic. Methods The clinical data of 45 cases( 1 case was cultured with two strains of bacteria,including a total of 46 strains of bacteria) with positive SBP ascites culture in the Second People's Hospital of Fuyang were collected and analyzed. Results The distribution of these 46 strains of bacteria was gram negative bacteria( G^- ) which accounted for 69. 6% and gram positive bacteria( G^+ ) which accounted for 30. 4%. Gmainly included Escherichia coli and Klebsiella pneumoniae,41. 3% and 17. 4% respectively,of which ESBLs bacteria reached to 51. 9%. G^+ mainly included plasma coagulase negative bacteria,accounting for 57. 1%. The results of drug sensitivity test showed that G^- was sensitive to imipenem while G^+ was sensitive to tigecycline and vancomycin. Conclusions The G^- pathogen in decompensative hepatitis B patients combined with spontaneous bacterial peritonitis is predominant,and Escherichia coli and Klebsiella pneumoniae are the main bacterias. The antibiotics should be selected according to the results of drug sensitivity test.