摘要
目的探讨老年肝硬化腹腔积液并发自发性细菌性腹膜炎病原菌的种类构成、耐药性特点,分析感染危险因素,对其治疗提供有效数据。方法在141例老年肝硬化腹腔积液并发自发性细菌性腹膜炎患者中选取40例腹腔积液细菌培养阳性的患者作为研究对象,收集其腹腔积液进行细菌培养并进行药敏试验;分别采用单因素分析及多因素logistic回归分析,对年龄、性别、并发症、外周血细胞、腹腔积液生化等危险因素进行分析。结果肝硬化腹腔积液并发自发性细菌性腹膜炎细菌感染革兰阴性杆菌占76.19%,主要为大肠埃希菌和鲍氏不动杆菌,革兰阳性球菌占23.81%,主要为表面葡萄球菌;病原菌对大多数抗菌药物产生不同程度的耐药性,革兰阴性杆菌对阿莫西林耐药性最高,>50.00%,对头孢菌素亦产生一定耐药,而对亚胺培南则普遍敏感,耐药率<6.00%;表皮葡萄球菌对头孢菌素、红霉素以及苯唑西林等均有较高的耐药性,耐药率为16.67%～50.00%,但对万古霉素较敏感,未发现耐药菌株;最终确定患者的年龄、腹腔积液多形核白细胞数量、腹腔积液蛋白水平、肝功能Child分级以及低钠血症等因素是SBP腹腔感染的危险因素(P<0.05)。结论治疗时可对老年肝硬化腹腔积液并发自发性细菌性腹膜炎患者的危险因素进行干预,发生感染时,应选择敏感抗菌药物进行治疗。
OBJECTIVE To explore characteristics such as composition of bacteria, drug sensitivity of bacterial infections of spontaneous bacterial peritonitis （SBP） in elderly patients with hepatic cirrhosis and to analyze related risk factors so as to guide the clinical treatment. METHODS A total of 40 SBP hepatic cirrhosis patients with bacterial infections were selected from 141 elderly patients with SBP. The bacterial identification and drug sensi-tive tests were performed after the seroperitoneum was collected. Single factor analysis and multivariate logistic regression analysis were performed to identify the risk factors for the bacterial infections in SBP patients with hepatic cirrhosis. RESULTS The gram-negative bacilli causing SBP in the patients with hepatic cirrhosis accounted for 76.19%, among which the Escherichia coli and Acinetobacter baumannii were the predominant species; the gram-positive cocci accounted for 23. 81%, among which the Staphylococcus epidermidis was dominant. The pathogens varied in the drug resistance to most of antibiotics, the drug resistance of the gram-negative bacilli to amoxicillin was the highest, the strains were also resistant to cephalosporins in a certain degree and were sensitive to imipenem. The gram-positive cocci were highly resistant to cephalosporins and erythromycin as well as oxacil-lin, but the strains were highly sensitive to vancomycin, no drug-resistant strains were found. The study conclu- ded that the age, PMN, hepatic function status, hyponatremia, and ascites albumin level were identified as risk factors for bacterial infections of SBP in elderly patients with hepatic cirrhosis. CONCLUSION The interventions to the risk factors could be helpful, and sensitive antibiotics should be chosen in treatment of the bacterial infections in the elderly with hepatic cirrhosis SBP.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2013年第11期2575-2577,共3页
Chinese Journal of Nosocomiology
关键词
肝硬化
自发性细菌性腹膜炎
老年
腹腔积液
Hepatic cirrhosis
Spontaneous bacterial peritonitis
Elderly
Seroperitoneum
