肝硬化并发自发性细菌性腹膜炎患者临床特点、病原学和药敏结果分析*

doi:10.3969/j.issn.1672-5069.2018.03.010

摘要/Abstract

摘要： 目的探讨肝硬化并发自发性细菌性腹膜炎（SBP）患者的临床特点、病原学分布和药敏情况。方法经细菌培养阳性的60例乙型肝炎肝硬化并发SBP患者,使用德国德灵诊断产品有限公司生产的细菌自动鉴定仪进行细菌鉴定,并采用纸片扩散(K-B)法或MIC法测定细菌对抗菌药物的敏感性。结果在60例SBP患者中,分离出大肠埃希菌8株（7.1%）、肺炎克雷伯菌7株（11.7%）、鲍曼不动杆菌10株（16.7%）、铜绿假单胞菌6株（10.0%）、阴沟肠杆菌4株（6.7%）、产气肠杆菌3株（5.0%）、葡萄球菌14株（23.3%）和肠球菌8株（13.3%）;对头孢西丁耐药的细菌有大肠埃希菌2株、肺炎克雷伯菌2株、鲍曼不动杆菌1株、铜绿假单胞菌2株、阴沟肠杆菌1株和产气肠杆菌1株;对头孢曲松耐药的细菌有大肠埃希菌1株,肺炎克雷伯菌1株,鲍曼不动杆菌3株,铜绿假单胞菌1株,阴沟肠杆菌2株和产气肠杆菌2株;对亚胺培南耐药的细菌有大肠埃希菌3株,肺炎克雷伯菌3株,鲍曼不动杆菌2株,铜绿假单胞菌1株,产气肠杆菌3株;对克林霉素耐药的细菌有凝固酶阴性葡萄球菌8株,肠球菌2株;对万古霉素耐药的细菌有葡萄球菌1株。结论肝硬化并发 SBP 患者细菌培养阳性率不高,但在成功分离得到的阳性细菌中以革兰阴性杆菌居多,对亚胺培南的敏感性在降低,而大多数革兰阳性菌仍对万古霉素敏感。

关键词: 自发性细菌性腹膜炎, 肝硬化, 病原学分布, 药敏

Abstract: Objective To investigate the clinical features,pathogenic distribution and drug susceptibility in patients with liver cirrhosis complicated by spontaneous bacterial peritonitis（SBP）. Methods 60 bacteria-culture positive patients with hepatitis B-induced liver cirrhosis complicated by SBP were analyzed in this study,and the bacteria were characterized by KB paper dispersion or MIC. Results Out of the 60 patients with SBP,we obtained Escherichia coli（E. coli） in 8（7.1%）,Klebsiella pneumoniae（KPN） in 7（11.7%）,Baumanii in 10（16.7%）,P. aeruginosa in 6（10.0%）,A. cloacae in 4（6.7%）,E. aerogenes in 3（5.0%）,coagulase-negative Staphylococcus （CNS） in 14（23.3%） and Enterococcus in 8（13.3%）;there were 2 strains of E. coli,2 strains of KPN,1 strain of Baumanii,2 strains of P. aeruginosa,2 strains of A. cloacae,and 1 strain of E. aerogenes resistant to cefoxitin; 1 strain of E. coli,1 strain of KPN,3 strains of Baumanii,1 strain of P. aeruginosa,and 2 strains of E. Aerogenes resistant to ceftriaxone;3 strains of E. coli, 3 strains of KPN,2 strains of Baumanii,1 strain of P. aeruginosa and 3 strains of E. Aerogenes resistant to imipenem;8 strains of CNS and 2 strains of Enterococcus resistant clindamycin,and 1 strain of CNS resistant to vancomycin. Conclusion s It's difficult to separate bacteria in patients with SBP,and the positive bacteria obtained in clinical practice are main Gram negative bacilli, which are susceptible to imipenem,and the Gram positive are sensitive to vancomycin.

Key words: Spontaneous bacterial peritonitis, Liver cirrhosis, Bacteria separation, Drug sensitivity

吴文豪, 符汉光, 陈朝琴. 肝硬化并发自发性细菌性腹膜炎患者临床特点、病原学和药敏结果分析*[J]. 实用肝脏病杂志, 2018, 21(3): 356-359.

Wu Wenhao, Fu Hanguang, Chen Zhaoqin. Clinical features,pathogenic distribution and drug susceptibility in patients with liver cirrhosis complicated by spontaneous bacterial peritonitis[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2018, 21(3): 356-359.

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