肝硬化合并自发性细菌性腹膜炎患者腹水病原菌分布及耐药情况

Distribution and Drug Resistance of Ascites Pathogens in Patients with Liver Cirrhosis and Spontaneous Bacterial Peritonitis

目的探讨肝硬化合并自发性细菌性腹膜炎(SBP)患者腹水培养的病原菌分布及对常见抗菌药物的耐药情况。方法纳入2012年1月~2019年7月天津市第二人民医院1253例肝硬化合并SBP并送检腹水培养的患者资料,进行菌种鉴定和药敏试验,分析病原菌分布及耐药情况。结果 214例腹水病原菌培养阳性(17.08%),共培养188株病原菌,其中革兰阳性菌93株(49.47%),革兰阴性菌95株(50.53%)。革兰阳性菌以屎肠球菌、人葡萄球菌人亚种、表皮葡萄球菌和头状葡萄球菌为主,共占59.14%;革兰阴性菌以大肠埃希菌和肺炎克雷伯菌为主,共占74.74%。药敏结果显示,屎肠球菌耐药率最高的3种药物为红霉素、克林霉素和四环素;人葡萄球菌人亚种、表皮葡萄球菌和头状葡萄球菌药率最高的3种药物均为红霉素、克林霉素和苄青霉素;大肠埃希菌药率最高的3种药物为氨苄西林、复方新诺明和头孢唑啉;肺炎克雷伯菌对氨苄西林耐药率最高。结论肝硬化合并自发性细菌性腹膜炎患者腹水培养病原菌中革兰阳性菌和革兰阴性菌比例接近,革兰阳性菌中屎肠球菌最多,革兰阴性菌中大肠埃希菌最多,临床治疗应依据病原菌药敏试验结果合理选用敏感性较高的抗生素。

Objective To investigate the distribution of pathogenic bacteria in ascites cultured in patients with liver cirrhosis complicated with spontaneous bacterial peritonitis(SBP) and drug resistance to common antibacterial drugs.Methods The data of 1,253 patients with liver cirrhosis combined with SBP and sent to ascites culture in Tianjin Second People’s Hospital from January 2012 to July 2019 were included. Strain identification and drug sensitivity tests were conducted to analyze the distribution of pathogens and drug resistance. Results A total of 214 cases of ascites pathogens were cultured positive(17.08%). A total of 188 strains of pathogens were cultured, including 93 Gram-positive bacteria(49.47%)and 95 Gram-negative bacteria(50.53%). Gram-positive bacteria were mainly Enterococcus faecium, Staphylococcus human subspecies,Staphylococcus epidermidis and Staphylococcus aureus, accounting for 59.14%;Gram-negative bacteria were mainly Escherichia coli and Klebsiella pneumoniae. A total of 74.74%. Drug susceptibility results show that the three drugs with the highest drug resistance rate of Enterococcus faecium are erythromycin, clindamycin and tetracycline;the three drugs with the highest drug resistance rate of Staphylococcus human subspecies, Staphylococcus epidermidis and Staphylococcus head all of them were erythromycin, clindamycin and benzylpenicillin;the three drugs with the highest Escherichia coli drug rates were ampicillin, co-trimoxazole and cefazolin;Klebsiella pneumoniae had the highest resistance rate to ampicillin. Conclusion The proportion of Gram-positive bacteria and Gram-negative bacteria in the ascites culture of patients with liver cirrhosis and spontaneous bacterial peritonitis is close. Gram-positive bacteria have the most Enterococcus faecium and Gram-negative bacteria have the most Escherichia coli. Clinical treatment should be reasonably select antibiotics with high sensitivity based on the results of pathogen susceptibility tests.