失代偿期乙型肝炎肝硬化并发自发性细菌性腹膜炎患者第三代头孢菌素类耐药情况调查*

doi:10.3969/j.issn.1672-5069.2025.01.023

摘要/Abstract

摘要： 目的分析失代偿期乙型肝炎肝硬化并发自发性细菌性腹膜炎(SBP)患者对第三代头孢菌素类耐药情况并探讨其影响因素。方法 2020年3月～2023年3月我院收治的失代偿期乙型肝炎肝硬化并发SBP并腹水培养阳性患者117例,接受第三代头孢菌素治疗。应用单因素和多因素Logistic回归分析影响耐药的因素。结果在本组117例患者中,共分离出细菌143株,其中革兰氏阳性菌54株(链球菌18株、肠球菌11株、葡萄球菌25株)和革兰氏阴性菌89株(大肠埃希菌43株、其他肠杆菌22株、不动杆菌10株、铜绿假单胞菌14株);在117例患者中,47例应用头孢曲松治疗,治疗有效率为78.7%,26例应用头孢吡肟治疗,治疗有效率为73.1%,19例应用头孢他啶治疗,治疗有效率为78.9%,25例应用头孢哌酮治疗,治疗有效率为80.0%;葡萄球菌对头孢曲松、头孢吡肟、头孢他啶和头孢哌酮的耐药率分别为68.0%、52.0%、40.0%和56.0%,大肠埃希菌的耐药率分别为62.8%、39.5%、25.6%和32.6%;47例耐药组既往SBP发作史和抗生素暴露史分别为23.4%和27.7%,显著高于非耐药组的7.1%和10.0%(P＜0.05);多因素Logistic回归分析显示,既往SBP发作史(OR:2.673,95%CI:1.556～4.592)和广谱抗生素暴露史(OR:2.295,95%CI:1.309～4.024)为肝硬化并发SBP患者对第三代头孢菌素类耐药的独立影响因素(P＜0.05)。结论本组失代偿期乙型肝炎肝硬化并发SBP患者多为大肠埃希菌等革兰阴性菌感染,对第三代头孢菌素类耐药率较高,值得临床重视和处理。

关键词: 肝硬化, 自发性细菌性腹膜炎, 第三代头孢类抗生素, 治疗, 耐药

Abstract: Objective The aim of this study was to investigate the prevalence of third-generation cephalosporin resistance in patients with decompensated hepatitis B liver cirrhosis (LC) and spontaneous bacterial peritonitis (SBP). Methods 117 patients with decompensated hepatitis B-induced LC and SBP who had ascites culture bacterial positive were encountered in our hospital between March 2020 and March 2023, and all received one of third generation cephalosporin treatment for 7 to 14 days. The univariate and multivariate Logistic regression were analyzed for the factors of third-generation cephalosporin resistance. Results Out of the 117 cirrhotics with SBP, we separated 143 strains of bacteria, including Gram-positive bacteria in 54 strains (18 Streptococcus, 11 Enterococcus and 25 Staphylococcus) and Gram-negative bacteria in 89 strains (43 strains of Escherichia Coli, 22 strains of other Enterobacter, 10 strains of Acinetobacter and 14 strains of Pseudomonas Aeruginosa); 47 patients received ceftriaxone, 26 patients received cefepime, 19 patients received ceftazidime and 25 patients received cefoperazone treatment with the effective rates of 78.7%, 73.1%, 78.9% and 80.0%, respectively; the resistant rates of Streptococcus to ceftriaxone, cefepime, ceftazidime and cefoperazone were 68.0%, 52.0%, 40.0% and 56.0%, and the resistant rates of Escherichia Coli to ceftriaxone, cefepime, ceftazidime and cefoperazone were 62.8%, 39.5%, 25.6% and 32.6%; the percentages of previous SBP episode history and broad-spectrum antibiotic exposure history in 47 patients with resistance to cephalosporin treatment were 23.4% and 27.7%, much higher than 7.1% and 10.0%(P＜0.05) in patients who sensitive to the therapy; the multivariate Logistic regression analysis showed that the previous SBP episode(OR:2.673,95%CI:1.556-4.592) and broad-spectrum antibiotic exposure history(OR:2.295,95%CI:1.309-4.024) were both the independent risk factors for resistance to cephalosporin (P＜0.05). Conclusion The cirrhotics with complicated SBP is commonly infected by Gram-negative bacteria, Escherichia Coli, for example, and is usually resistant to cephalosporins, and the clinicians should deal with it appropriately.

Key words: Liver cirrhosis, Spontaneous bacterial peritonitis, Third generation cephalosporin, Therapy, Drug resistance

沈莉莉, 赵琳, 石磊. 失代偿期乙型肝炎肝硬化并发自发性细菌性腹膜炎患者第三代头孢菌素类耐药情况调查^*[J]. 实用肝脏病杂志, 2025, 28(1): 88-91.

Shen Lili, Zhao Lin, Shi Lei. Prevalence of third-generation cephalosporin resistance in patients with decompensated hepatitis B cirrhosis and spontaneous bacterial peritonitis[J]. Journal of Practical Hepatology, 2025, 28(1): 88-91.

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失代偿期乙型肝炎肝硬化并发自发性细菌性腹膜炎患者第三代头孢菌素类耐药情况调查^*

Prevalence of third-generation cephalosporin resistance in patients with decompensated hepatitis B cirrhosis and spontaneous bacterial peritonitis

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