肝硬化并发自发性细菌性腹膜炎腹水病原菌及耐药性分析

目的 了解肝硬化并发自发性细菌性腹膜炎腹水培养的病原菌构成及其对抗菌药物的耐药性,为指导临床合理用药提供依据.方法 回顾性分析2008-2013年本院住院肝硬化合并自发性细菌性腹膜炎患者送检腹水标本中分离的病原菌及对临床常用抗菌药物的耐药性情况.结果 肝硬化并发自发性细菌性腹膜炎病原菌以革兰氏阴性杆菌为主38株（70.4％）,革兰氏阳性菌16株（29.6％）.革兰氏阴性菌以大肠埃希菌、肺炎克雷伯菌为主,革兰氏阳性菌以凝固酶阴性葡萄球菌属及肠球菌属为主.药敏结果显示,革兰氏阴性杆菌对亚胺培南、哌拉西林/他唑巴坦、头孢吡肟的抗菌活性较好,对氨苄西林高度耐药;而革兰氏阳性球菌对万古霉素及利奈唑胺敏感,对其他常用药物耐药率均较高.结论 肝硬化并发自发性细菌性腹膜炎的病原菌以革兰氏阴性菌最常见.临床应根据腹水细菌培养和药敏试验结果,合理应用抗菌药物,减少耐药菌株的产生.

Composition of pathogens and drug resistance in patients of liver cirrhosis complicated with spontaneous bacterial peritonitis

Objective To investigate the composition and antibiotic-resistance of pathogens in patients of liv- er cirrhosis complicated with concurrent spontaneous bacterial peritonitis （SBP）, and provide basis for the clinical rea- sonable application of antibiotics. Methods The results of bacterial culture and drug sensitivity tests of ascitic speci- mens from cirrhotic patients with SBP in our hospital from 2008 to 2013 were retrospectively analyzed. Results The Gram-negative bacilli （38 strains, 70.4% ） covered the largest percentage of pathogenic bacteria, followed by the Gram-positive cocci （16 strains, 29.6%）. Among Gram-negative bacilli, Escherichia coli and the Klebsiella pneumoni- ae were the most common. In the Gram-positive cocci, coagulase-negative staphylococcus and Enterococcus were the most common. Gram-negative bacilli were sensitive to imipenem, piperacillin/tazobactam and cefepime but highly re- sistant to ampicillin. Gram-positive cocci were sensitive to vancomycin and linezolid but highly resistant to commonly used antibiotics. Conclusion The main pathogens of liver cirrhosis complicated with SBP was Gram-negative bacil- li. We should reasonably choose the antibiotics according to the results of the pathogens sensitivity to drugs in clinic, and decrease the production of drug resistance.