肝硬化并发自发性细菌性腹膜炎病原菌的临床分布与耐药分析

目的 了解肝硬化并发自发性细菌性腹膜炎(SBP)患者感染病原菌的临床分布及耐药现状,为临床治疗提供依据.方法 对该院2005～2011年住院部肝病科诊断为肝硬化并发SBP患者送检的腹水标本分离培养鉴定的细菌及耐药性进行回顾性分析.结果 肝硬化并发SBP患者腹水中共分离菌株71株,检出率由高至低依次为大肠埃希菌(49.30%)、肺炎克雷伯菌(30.99%)、粪肠球菌(16.90%),其中超广谱β-内酰胺酶(ESBLs)阳性的大肠埃希菌和肺炎克雷伯菌分别为31.42%、40.91%.大肠埃希菌和肺炎克雷伯菌对哌拉西林、头孢菌素、环丙沙星耐药率较高,对阿米卡星、米诺环素耐药率相对较低,肠球菌对青霉素、氨苄西林耐药率相对较低,对红霉素耐药率较高.未发现耐万古霉素粪肠球菌.结论 革兰阴性杆菌为肝硬化并发SBP患者主要病原菌,革兰阳性球菌检出率相对较低,其中粪肠球菌耐药现象较轻.ESBLs阳性大肠埃希菌和肺炎克雷伯菌多药耐药现象严重.

Clinical distribution and drug resistance analysis of pathogens causing liver cirrhosis complicated with spontaneous bacterial peritonitis

Objective To investigate the clinical distribution and drug resistance of pathogens isolated from patients with liver cirrhosis complicated with spontaneous bacteria peritonitis(SBP).Methods Clinical distribution and drug resistance of bacterial strains,isolated from ascites samples of patients with liver cirrhosis complicated with SBP of Inpatient Department of Hepatology during 2005 and 2011,were retrospectively analyzedResults Total of 71 strains of bacteria were isolated.The isolation rates of mainly clinical strains,ranged from high to low,were 49.29% for Escherichia coli,30.99% for Klebsiella peneumoniae and 16.90% for Enterococcus faecalis.Among strains of Escherichia coli and Klebsiella pneumoniae,the detection rates of strains,producing extended spectrum beta-lactamase(ESBLs),were 31.42% and 40.91%.Drug resistance rates of Escherichia coli and Klebsiella pneumoniae to Piperacillin,Cephalosporin and Ciprofloxacin were relatively high,but to Amikacin,Chloramphenicol and Minocycline were relatively low.Drug resistance rates of Enterococcus faecalis to Penicillin and Ampicillin were relatively low,but to Erythromycin and Clindamycin were relatively high.No vancomycin-resistant Enterococcus faecalis were isolated.Conclusion Gram-negative baclli might be the main pathogens causing liver cirrhosis complicated with SBP.The detection rate of Gram-positive cocci might be relatively low.Enterococcus faecalis might be with low drug resistance rate to antibiotics.Escherichia coli and Klebsiella pneumoniae,producing ESBLs,might be with serious multi-drug resistance.