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