肝硬化患者发生自发性细菌性腹膜炎的危险因素及病原菌耐药分析

Risk factors and pathogen analysis of spontaneous bacterial peritonitis in patients with liver cirrhosis

目的分析肝硬化腹腔积液患者发生自发性细菌性腹膜炎(SBP)的危险因素、病原菌及耐药抗生素。方法回顾性收集2020年1月至2022年12月于山西医科大学第一医院住院的肝硬化腹腔积液患者临床资料,按照有无发生SBP分为非SBP组、SBP组,比较2组患者的一般资料、临床特征、实验室检查、病原学结果,分析肝硬化患者发生SBP的危险因素、病原菌及耐药抗生素。结果单因素分析显示2组患者在上消化道出血、肝性脑病、白蛋白(ALB)、总胆红素(TBIL)、直接胆红素(DBIL)、凝血酶原时间、凝血酶原活动度、国际标准化比值(INR)、白细胞计数(WBC)、中性粒细胞比例(NEUT%)、钠、尿素、肌酐、降钙素原(PCT)差异具有统计学意义(P均<0.05),将单因素有统计学意义的变量作为自变量进行多因素Logistic回归分析显示上消化道出血、钠、尿素、PCT水平是肝硬化发生SBP的独立危险因素(P均<0.05);SBP患者中分离出的病原菌主要以革兰阳性菌(GPB)为主(61.4%),GPB最常见的耐药抗生素为红霉素,耐药率为96.0%,而对万古霉素、替加环素、利奈唑胺无耐药;革兰阴性菌(GNP)最常见的耐药抗生素为左氧氟沙星,耐药率为71.4%,对厄他培南、美罗培南耐药率较低为14.3%。结论当肝硬化腹腔积液患者出现上消化道出血、低钠血症、高尿素、PCT水平升高时应高度警惕SBP的发生,必要时及早干预,提高患者生存率。SBP最常见的病原菌为GPB,应高度重视SBP发病中GPB耐药。

Objective To analyze the risk factors,pathogenic bacteria,and antibiotic resistance of spontaneous bacterial peritonitis(SBP)in liver cirrhotic patients with ascites.Methods The clinical data of patients with ascites due to liver cirrhosis hospitalized in the First Hospital of Shanxi Medical University from January 2020 to December 2022 were retrospectively collected,and they were divided into non-SBP group and SBP group according to whether SBP occurred or not.The general data,clinical characteristics,laboratory examination,and pathogenic results of the two groups were compared,and the risk factors,pathogenic bacteria,and drug-resistant antibiotics of patients with liver cirrhosis were analyzed.Results Univariate analysis showed that there were statistical differences in upper gastrointestinal bleeding,hepatic encephalopathy,ALB,TBIL,DBIL,prothrombin time,prothrombin activity,INR,WBC,NEUT%,sodium,urea,creatinine and PCT between the two groups(all P<0.05).Multivariate Logistic regression analysis showed that upper gastrointestinal bleeding,sodium,urea,and PCT levels were independent risk factors for SBP in liver cirrhosis(P<0.05).The main pathogen isolated from SBP patients was GPB(61.4%).Erythromycin was the most common antibiotic resistant to GPB,with a resistance rate of 96.0%,but it was not resistant to vancomycin,tigecycline,and linezolid.Levofloxacin was the most common drug-resistant antibiotic in GNB,with a resistance rate of 71.4%,while the resistance rate to ertapenem and meropenem was 14.3%.Conclusion When upper gastrointestinal bleeding,hyponatremia,high urea,and PCT levels rise in patients with ascites due to liver cirrhosis,we should be highly alert to the occurrence of SBP,and intervene as early as possible if necessary to improve the survival rate of patients.The most common pathogen of SBP is GPB,so we should attach great importance to the incidence of GPB in SBP pathogens.Enterococcus faecium is the most common GPB and has no resistance to vancomycin,tigecycline,and linezolid.