乙型肝炎肝硬化并自发性细菌性腹膜炎的病原学及耐药性分析

目的分析乙型肝炎肝硬化并发自发性细菌性腹膜炎（SBP）患者的腹水病原菌分布及其耐药性，为临床合理使用抗菌药物提供依据。 方法选取2010年1月至2017年12月成都市公共卫生临床医疗中心收治的762例乙型肝炎肝硬化并SBP患者，经患者同意后抽取腹水做病原学鉴定及药敏试验。 结果762例患者中，158例腹水培养结果显示病原菌阳性（阳性率为20.73%，158/762），共检出病原菌166株，除7例患者为复合菌感染，余151例（95.57%）均为单菌感染。166株病原菌中，革兰阳性菌98株（59.04%），革兰阴性菌59株（35.54%），真菌9株（5.42%），其中产超广谱β-内酰胺酶（ESBLs）病原菌共22株（13.25%）。革兰阳性菌以溶血葡萄球菌、表皮葡萄球菌、科氏葡萄球菌及粪肠球菌为主，占革兰阳性杆菌的59.18%（58/98）；对青霉素G、红霉素、克林霉素、苯唑西林及四环素耐药率最高，而对万古霉素和替考拉宁的耐药率均为0。革兰阴性杆菌以大肠埃希菌和肺炎克雷伯菌为主，占革兰阴性杆菌的72.88%（43/59）；对氨苄西林耐药率最高（62.79%），而对亚胺培南和美罗培南的耐药率均为0。 结论乙型肝炎肝硬化并发自发性细菌性腹膜炎患者的病原菌以大肠埃希菌、肺炎克雷伯菌和溶血葡萄球菌为主，临床医生应根据腹水病原学鉴定及其药敏试验结果合理使用抗菌药物。

Distribution and drug resistance of pathogens in ascites of patients with hepatitis B-related liver cirrhosis complicated with spontaneous bacterial peritonitis

ObjectiveTo investigate the distribution and drug resistance of pathogens in ascites of patients with hepatitis B virus (HBV)-related liver cirrhosis complicated with spontaneous bacterial peritonitis (SBP), and to provide references to clinical rational drug use. MethodsTotal of 762 HBV-related liver cirrhosis patients complicated with SBP in Public Health Clinical Center of Chengdu from January 2010 to December 2017 were enrolled after informed consent. The pathogens identification and drug susceptibility test of the ascites specimens were performed. ResultsAmong the 762 patients, 158 cases were positive for pathogen culture, with the positive rate of 20.73%, and 166 strains of pathogenic bacteria were isolated, among which 151 patients (95.57%) with single infection, except for 7 patients as composite infection. A total of 98 strains (59.94%) were Gram-positive bacteria, 59 strains (35.54%) were Gram-negative bacteria and 9 strains (5.42%) were fungi, while 22 strains (13.25%) of extended-spectrum β-Lactamases (ESBLs)-producing bacteria were isolated. The most commonly isolated Gram-positive bacteria were Staphylococcus haemolyticus, Staphylococcus epidermidis, Staphylococcus cohnii and Enterococcus faecalis, with a total of 59.18% (58/98) in Gram-positive bacteria, remained highly resistance to penicillin G, erythrocin, clindamycin, oxacillin and tetracycline, but no resistance to vancomycin or teicoplanin strains occurred. Escherichia coli and Klebsiella pneumonia were dominant among the Gram-negative bacteria, accounting for 72.88% (43/59), mostly resistant to ampicillin, but none to imipenem or meropenem. ConclusionsHBV-related liver cirrhosis patients with SBP are infected mainly by Escherichia coli, Klebsiella pneumonia and Staphylococcus haemolyticus. Clinicians should use antibiotics reasonably based on the ascites pathogen identification and drug resistance.