肝硬化腹水伴自发性细菌性腹膜炎患者第三代头孢菌素耐药的危险因素研究

Study on risk factors of third generation cephalosporin resistance in patients with cirrhosis ascites and spontaneous bacterial peritonitis

目的研究肝硬化腹水伴自发性细菌性腹膜炎(SBP)患者第三代头孢菌素耐药的危险因素。方法回顾性分析2014年11月至2019年11月期间京山市人民医院收治的158例肝硬化腹水伴SBP患者的临床资料。按照药敏结果分为耐药组(77例,腹水病原菌对第三代头孢菌素耐药者)和非耐药组(81例,腹水病原菌对第三代头孢菌素非耐药者)。比较两组病原菌构成情况,采用多因素Logistic回归分析肝硬化腹水伴SBP患者第三代头孢菌素耐药的独立影响因素。结果药敏鉴定涉及的第三代头孢菌素种类包括头孢他啶、头孢曲松、头孢哌酮、头孢噻肟,耐药组病原菌对上述四种药物均耐药,非耐药组均不耐药。耐药组大肠埃希菌、粪肠球菌所占比例显著高于非耐药组(P<0.05),肺炎克雷伯菌、链球菌、棒状杆菌所占比例显著低于非耐药组(P<0.05)。耐药组近3月广谱抗菌素暴露史、SBP非首次发病所占比例显著高于非耐药组(P<0.05),血肌酐水平显著高于非耐药组(P<0.05),且血碳酸氢盐水平显著低于非耐药组(P<0.05)。近3月广谱抗菌素暴露史、SBP非首次发病、血碳酸氢盐是肝硬化腹水伴SBP患者第三代头孢菌素耐药的独立影响因素(P<0.05)。结论肝硬化腹水伴SBP患者第三代头孢菌素耐药与近3月广谱抗菌素暴露史、SBP非首次发病、血碳酸氢盐偏低密切相关,具备这类特征者临床治疗应合理选择第三代头孢菌素。

Objective To study the risk factors for third-generation cephalosporin resistant bacteria infection in patients with cirrhosis ascites and spontaneous bacterial peritonitis(SBP).Methods The clinical data of 158 cirrhotic ascites patients with SBP from November 2014 to November 2019 were analyzed retrospectively.According to the results of drug sensitivity,the patients were divided into resistance group(77 cases with third-generation cephalosporin resistant bacteria in ascites)and non-resistance group(81 cases without third-generation cephalosporin resistant bacteria in ascites).The composition of pathogenic bacteria in the 2 groups was investigated.And the independent influencing factors for third-generation cephalosporin resistant bacteria infection in patients with cirrhosis ascites and SBP were analyzed by multivariate logistic regression.Results The types of third-generation cephalosporins involved in drug susceptibility testing included ceftazidime,ceftriaxone,cefoperazone and cefotaxime.Pathogens in the resistance group were resistant to the above 4 drugs,while those in the non-resistance group were sensitive.The proportions of Escherichia coli and Enterococcus faecalis in the resistance group were significantly higher than those in the non-resistance group(P<0.05),while the proportions of Klebsiella pneumoniae,Streptococcus and Corynebacterium were significantly lower than those in the non-resistance group(P<0.05).The proportions of patients with broad-spectrum antibiotics exposure in recent 3 months and reemerging SBP in the resistance group were significantly higher than those in the non-resistance group(P<0.05).The blood creatinine level was significantly higher in the resistance group than that in the non-resistance group(P<0.05),and the blood bicarbonate level was significantly lower in the resistance group than that in the non-resistance group(P<0.05).Broad-spectrum antibiotic exposure in recent 3 months,SBP history and blood bicarbonate were independent influencing factors for the third-generation cephalosporin resistance bacteria infection in patients with cirrhotic ascites and SBP(P<0.05).Conclusion Broad-spectrum antibiotic exposure in recent 3 months,SBP history,and low-level blood bicarbonate are closely related to the infection of third-generation cephalosporin resistant bacteria in patients with cirrhosis ascites and SBP.Selection of third-generation cephalosporin in patients with these characteristics should be with more caution.