第三代头孢菌素耐药的自发性细菌性腹膜炎发生的预测因素

Predictive factors for third-generation cephalosporin-resistant spontaneous bacterial peritonitis

目的探讨第三代头孢菌素(3rdGC)耐药的自发性细菌性腹膜炎(3rdGCR SBP)发生的预测因素。方法回顾性收集2010年1月-至2018年12月在南昌市第九医院住院的206例肝硬化患者临床资料,均合并腹水培养单株细菌阳性的SBP。依据药敏结果,腹水病原菌对3rdGC耐药者纳入3rdGCR SBP组(n=101),敏感者纳入对照组(n=105)。查阅患者电子病历采集各项信息。符合正态分布的计量资料2组间比较采用t检验;偏态分布数据2组间比较采用Mann-Whitney U检验。计数资料2组间比较采用χ^2检验或Fisher精确概率法。多因素分析采用二分类Logistic回归,自变量筛选采用Forward:LR法。结果 2组病原菌构成差异有统计学意义(P <0. 001)。单因素分析中,2组间差异有统计学意义的候选预测指标为近3月广谱抗菌素暴露史(χ^2=12. 351,P <0. 001)、SBP非首次发病(χ^2=14. 427,P <0. 001)、血肌酐(χ^2=-2. 537,P=0. 011)及血碳酸氢盐(Z=-4. 592,P <0. 001),进一步多因素分析发现近3月广谱抗菌素暴露史[比值比(OR)=2. 376,95%置信区间(95%CI):1. 009~5. 598,P=0. 048]、SBP非首次发病(OR=2. 841,95%CI:1. 133~7. 122,P=0. 026)及血碳酸氢盐(OR=0. 892,95%CI:0. 818~0. 973,P=0. 010)对3rdGCR SBP具有独立预测价值。结论近3月广谱抗菌素暴露史、SBP非首次发病及低水平血碳酸氢盐是3rdGCR SBP的独立预测因素,具有这些特征的SBP患者应慎用3rdGC治疗。

Objective To investigate the predictive factors for third-generation cephalosporin-resistant spontaneous bacterial peritonitis( SBP). Methods A retrospective analysis was performed for the clinical data of 206 patients with liver cirrhosis who were hospitalized in the Ninth Hospital of Nanchang from January 2010 to December 2018,and all patients had SBP with positive bacteria based on ascites culture. According to drug susceptibility results,the patients were divided into third-generation cephalosporin-resistant SBP group( 101 patients with third-generation cephalosporin-resistant pathogenic bacteria in ascites) and control group( 105 patients with pathogenic bacteria sensitive to third-generation cephalosporin). Electronic medical records were reviewed to collect related information. The t-test was used for comparison of normally distributed continuous data between groups,and the Mann-Whitney U test was used for comparison of data with skewed distribution between groups. The chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups. A dichotomous logistic regression analysis was used for multivariate analysis,and the Forward: LR method was used for the screening of independent variables. Results There was a significant difference in the composition of pathogenic bacteria between the two groups( P <0. 001). The univariate analysis showed that a history of broad-spectrum antibiotic exposure in the past three months( χ~2= 12. 351,P <0. 001),non-first-time onset of SBP( χ~2= 14. 427,P < 0. 001),blood creatinine( χ~2=-2. 537,P = 0. 011),and blood bicarbonate( χ~2=-4. 592,P < 0. 001) were candidate predictive factors with statistical significance between the two groups,and further multivariate analysis showed that a history of broad-spectrum antibiotic exposure in the past three months( odds ratio [OR]= 2. 376,95% confidence interval [CI]: 1. 009-5. 598,P = 0. 048),non-first-time onset of SBP( OR = 2. 841,95% CI: 1. 133-7. 122,P = 0. 026),and blood bicarbonate( OR = 0. 892,95% CI: 0. 818-0. 973,P = 0. 010) had an independent predictive value for third-generation cephalosporin-resistant SBP. Conclusion A history of broad-spectrum antibiotic exposure in the past three months,non-first-time onset of SBP,and a low level of blood bicarbonate are independent predictive factors for third-generation cephalosporin-resistant SBP,and third-generation cephalosporins should be used with caution in SBP patients with these features.