慢性肝衰竭并发自发性细菌性腹膜炎患者细菌培养和抗生素选用临床研究

目的：了解慢性肝衰竭并发自发性细菌性腹膜炎（SBP）患者致病菌感染谱和耐药性的变化,为临床经验性使用抗菌药物提供依据。方法：从慢性肝衰竭并发SBP患者的腹水中分离细菌,采用美国BD公司的Sceptor细菌鉴定仪和法国梅里埃API生化鉴定条进行鉴定,并按美国临床实验标准委员会2000年判断标准用纸片扩散法进行药物敏感实验。结果：共分离出病原菌168株,革兰阴性杆菌中以大肠埃希菌72株（42.86%）、肺炎克雷伯菌24株（14.29%）为主。耐药性分析显示：革兰阴性杆菌对临床常用抗生素呈多重耐药,耐药率最低为亚胺培南（12.7%）,最高为氨苄西林（82.7%）。结论：依据细菌病原学及抗菌药物敏感性资料,选择抗生素控制SBP感染,不断进行耐药性监测,掌握细菌变迁动态,指导临床合理应用抗菌药物,并减少新的耐药菌株的出现。

Bacterial Culture and Use of Antibacterias for Patients with Chronic Hepatic Failure Complicating Spontaneous Bacterial Peritionitis

OBJECTIVE： To study the pathogen spectra and drug resistance in patients with chronic hepatic failure complicating spontaneous bacterial peritonitis （SBP） for reference of clinical empiric use of antibiotics. METHODS： Bacteria were isolated from patients with chronic hepatic failure complicateing SBP and identified using Sceptor bacteria analyzer （BD Inc, USA） and API biochemical identification strip （API Inc, France）. Drug susceptibility test was performed by standard disc diffusion method in accordance with guidelines of US NCCLS （2000）. RESULTS： A total of 168 strains of pathogenic bacteria were isolated, of which, 72 （42.86%） were Eseherichia coli and 24 （14.29%） were Klebsiella pneumoniae. The drug resistance test showed that Gram - negative bacilli were muhiresistant to common clinical antibiotics, which showed lowest resistance rate （12.7%） to imipenem but highest resistance （82.7%） to ampicillin. CONCLUSION： The use of antibiotics for SBP infection control should be based on etiology and drug susceptibility data, furthermore, drug resistance should be monitored throughout the treatment course to get information about the dynamic change of bacteria so as to guide rational drug use in the clinic and reduce the presence of new drug resistant strains.