摘要
目的 探讨肝硬化合并自发性细菌性腹膜炎（SBP）患者中医院感染与社区感染病原菌分布特点及耐药情况.方法 纳入北京地坛医院2001年1月至2008年12月腹水细菌培养阳性的肝硬化合并SBP患者226例,鉴定细菌并行药物敏感试验,数据行卡方检验和t检验.结果 医院感染的SBP患者共86例,占38.0%;社区感染的140例,占62.0%;Child-Pugh分级C级在医院感染和社区感染中各占97.7%和82.8%（Х^2=11.489,P=0.001）,病死率分别为50.0%和30.0%（Х^2=9.081,P=0.003）.腹水细菌培养出病原菌共232株、28种,其中医院感染SBP及社区感染SBP病原菌均以革兰阴性菌为主,分别占77.5%和76.9%,列前两位的均是大肠埃希菌和肺炎克雷伯菌,革兰阳性菌分别占19.1%和21.7%,真菌占3.4%和1.4%（P＞0.05）.医院感染的SBP 32株大肠埃希菌和14株肺炎克雷伯菌中,分别有19株和5株产β-内酰胺酶（ESBL）;社区感染的SBP60株大肠埃希菌和32株肺炎克雷伯菌中,只有11株大肠埃希菌产ESBL（P＜0.05）.医院感染SBP革兰阴性菌对头孢菌素及喹诺酮耐药率明显高于社区感染SBP（P＜0.05）,但均对亚胺培南较敏感（P＞0.05）;医院感染SBP及社区感染SBP的革兰阳性菌株中,未发现对万古霉素耐药.结论 Child-Pugh C级肝硬化患者更易发生医院感染的SBP,且预后差;医院感染SBP及社区感染SBP病原菌群分布相似,以大肠埃希菌和肺炎克雷伯菌为主,但产ESBL阳性率明显升高.
Objective To investigate the pathogenic features and antibiotic resistance profile of nosocomial and community-acquired spontaneous bacterial peritonitis （SBP） in liver cirrhosis patients.Methods Two hundred and twenty-six cirrhotic patients with SBP who were admitted to Beijin Ditan Hospital from January 2001 to December 2008 were recruited into this study. The bacterial identification and drug susceptibility were performed. The data were analyzed by Chi square test and t test. Results Eighty-six（38.0% ） patients were diagnosed with nosocomial SBP and 140 （62.0%）were diagnosed with community-acquired SBP. The proportion of Child-Pugh Class C cases in patients with nosocomial SBP was higher than patients with community acquired SBP （97.7% vs. 82.8%; Х^2= 11. 489, P=0.001）. Mortality rate in patients with nosocomiat SBP was also higher than patients with community acquired SBP （50. 0% vs. 30. 0%; Х^2 =9. 081,P=0. 003）. Total 28 species （232strains） of bacteria were isolated from these patients. 77.5 % （69/89） of the nosomial SBP cases and 76.9% （110/143） of community-acquired SBP cases were caused by Gram-negative bacteria （mainly were Escherichia coli and Klebsiella pneumoniae）. 19.1% nosocomial SBP cases and 21. 8%community-acquired SBP cases were caused by Gram-positive bacteria. Fungus infections accounted for 3.4% and 1.4% of these two population, respectively（P〉0.05）. In patients with nosocomial SBP,19 out of 32 Escherichia coli stains and 5 out of 14 Klebsiella pneunmoniae strains were extended spectrum β-lactamase （ESBL） positive, while among 60 Escherichia coli stains and 32 Klebsiella pneunmoniae strains, only 11 Escherichia coli stains were ESBL positive （P〈0.05）. The resistance rates of Gram-negative strains to cephalosporin and quinolone in nosocomial SBP patients were both higher than those in community-acquired SBP patients（P〈0. 05）, but all Gram-negative isolates were sensitive to imipenem （P〉 0. 05）. No Gram-positive isolates resistant to vancomycin were found.Conclusions The liver cirrhosis patients with Child-Pugh Class C are vulnerable to nosocomial SBP and the prognosis is poor. Although the pathogenic spectrum are similar in cirrhotic patients with nosocomial and community-acquired SBP, which mainly are Escherichia coli and Klebsiella pneumoniae, the percentage of ESBL producing strains is higher in nosocomial SBP patients compared to that in community-acquired SBP patients.
出处
《中华传染病杂志》
CAS
CSCD
北大核心
2010年第10期611-614,共4页
Chinese Journal of Infectious Diseases
关键词
交叉感染
腹膜炎
肝硬化
大肠埃希菌
克雷伯菌
肺炎
抗药性
细菌
Cross infection
Peritonitis
Liver cirrhosis
Escherichia coli
Klebsiella pneumoniae
Drug resistance, becterial
