Pathogen profile and drug resistance analysis of spontaneous peritonitis in cirrhotic patients
Pathogen profile and drug resistance analysis of spontaneous peritonitis in cirrhotic patients
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DOI：
10.3748/wjg.v21.i36.10409
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发表时间：
2015-09-28
影响因子：
4.3
通讯作者：
Li, Lan-Juan
中科院分区：
文献类型：
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作者：
Li, Yong-Tao;Yu, Cheng-Bo;Li, Lan-Juan
目的：为了解肝硬化并发自发性腹膜炎患者的细菌学特征及耐药性，对浙江大学附属第一医院2011年1月-2013年12月肝硬化并发腹腔感染患者的临床资料进行分析。结果：我们从288例患者中分离出306株病原菌：178例患者中，革兰阴性菌感染（58.2%）; 85例患者中，革兰阳性菌感染（27.8%）; 9例患者中，真菌感染（2.9%）; 16例患者中，多种病原菌感染。主要致病菌为大肠杆菌（Escherichia coli，E.大肠埃希菌（24.2%）、肺炎克雷伯菌（18.9%）、肠球菌属（18.9%）。(11.1金黄色葡萄球菌（7.5%）。在306个分离的病原体中，99个引起医院感染，207个引起社区获得性和其他感染。急诊埃希菌和医院感染患者肺炎克雷伯菌产超广谱β-内酰胺酶的比例高于非医院感染患者（分别为62.5%和36.8%，P < 0.013和12.8%，P < 0.034）。医院感染和非医院感染对抗生素的敏感性不同：瑞拉西林/他唑巴坦对非医院感染的E.大肠埃希菌感染（4% vs20.8%，P < 0.021）。呋喃妥因对引起非医院感染的肠球菌有较强的抗菌活性（36.4% vs86.3%，P < 0.009）。结论：肝硬化患者腹腔感染的病原菌以革兰阴性菌为主，医院感染的耐药性明显高于非医院感染。
AIM: To investigate the microbiological characteristics and drug resistance in liver cirrhosis patients with spontaneous peritonitis.METHODS: We analyzed the data of patients with liver cirrhosis and abdominal infection at the First Affiliated Hospital of Zhejiang University between January 2011 and December 2013. Pathogens present in the ascites were identified, and their sensitivity to various antibiotics was determined.RESULTS: We isolated 306 pathogenic bacteria from 288 cases: In 178 cases, the infection was caused by gram-negative strains (58.2%); in 85 cases, gram-positive strains (27.8%); in 9 cases, fungi (2.9%); and in 16 cases, more than one pathogen. The main pathogens were Escherichia coli (E. coli) (24.2%), Klebsiella pneumoniae (18.9%), Enterococcus spp. (11.1%), and Staphylococcus aureus (7.5%). Of the 306 isolated pathogens, 99 caused nosocomial infections and 207 caused community-acquired and other infections. The E. coli and K. pneumoniae strains produced more extended-spectrum beta-lactamases in cases of nosocomial infections than non-nosocomial infections (62.5% vs 38%, P < 0.013; 36.8% vs 12.8%, P < 0.034, respectively). The sensitivity to individual antibiotics differed between nosocomial and non-nosocomial infections: Piperacillin/tazobactam was significantly more effective against non-nosocomial E. coli infections (4% vs 20.8%, P < 0.021). Nitrofurantoin had stronger antibacterial activity against Enterococcus species causing non-nosocomial infections (36.4% vs 86.3%, P < 0.009).CONCLUSION: The majority of pathogens that cause abdominal infection in patients with liver cirrhosis are gram-negative, and drug resistance is significantly higher in nosocomial infections than in non-nosocomial infections.