肝硬化患者腹腔感染的病原菌分布与耐药性分析

发布时间：2019-06-24 14:18

【摘要】：目的分析肝硬化患者失代偿期并发腹腔感染的病原菌分布及其耐药性,为合理使用抗菌药物提供参考依据。方法选取2014年10月-2017年2月医院收治的肝硬化失代偿期并发腹腔感染患者320例为研究对象,腹腔穿刺术后留取患者腹水标本进行细菌鉴定和药敏试验。结果 320例患者中病原菌培养阳性83例,阳性率为25.94%;腹水培养阳性患者共检出病原菌136株,其中革兰阴性菌89株占65.44%;革兰阳性菌43株占31.62%;真菌4株占2.94%;主要革兰阴性菌为大肠埃希菌、肺炎克雷伯菌及铜绿假单胞菌,其中大肠埃希菌对碳青霉烯类抗菌药物(亚胺培南、美罗培南等)及半合成青霉素与β-内酰胺酶抑制剂合成制剂(哌拉西林/他唑巴坦)耐药率为0,肺炎克雷伯菌对β-内酰胺类抗菌药物普遍耐药,尤其是阿莫西林,其耐药率达100.00%,而对碳青霉烯类抗菌药物(亚胺培南等)耐药率为0,铜绿假单胞菌对亚胺培南及阿米卡星耐药率为0;主要革兰阳性菌为表皮葡萄球菌与肺炎链球菌,两者均对青霉素产生耐药,耐药率达100.00%;表皮葡萄球菌对万古霉素、替考拉宁及阿米卡星耐药率为0;肺炎链球菌仅对万古霉素及替考拉宁耐药率为0。结论肝硬化患者腹腔感染病原菌主要为革兰阴性菌,且以大肠埃希菌和肺炎克雷伯菌为主,并对亚胺培南、美罗培南均敏感,可作为临床首选用药;而对三、四代头孢菌素的耐药率有上升趋势,临床应根据具体药敏结果进行治疗。
[Abstract]:Objective To analyze the distribution of the pathogenic bacteria and the drug resistance of the patients with liver cirrhosis complicated with celiac infection, and provide the reference for the rational use of the antibacterial drugs. Methods 320 patients with decompensation of liver cirrhosis and 320 patients with celiac infection were selected from Oct.,2014 to February,2017. Results Among the 320 patients, the positive rate was 25.94%, the positive rate was 25.94%, and 136 strains of the pathogenic bacteria were detected in the positive patients with ascites, among which,89 strains of Gram-negative bacteria accounted for 65.44%,43 of the Gram-positive bacteria accounted for 31.62%,4 of the fungi accounted for 2.94%, and the main Gram-negative bacteria were E. coli, Klebsiella pneumoniae and Pseudomonas aeruginosa, wherein E. coli has a resistance rate of 0 to carbapenem antibacterial drugs (imipenem, meropenem, etc.) and a semi-synthetic penicillins and a combination of a combination of penicillins and e-aminidase inhibitors ( The resistance rate of klebsiella pneumoniae to the anti-bacterial drugs, especially amoxicillin, was 100.00%, while the resistance rate of carbapenems to carbapenems (imipenem and the like) was 0, and the resistance rate of Pseudomonas aeruginosa to imipenem and amikacin was 0. The main Gram-positive bacteria were Staphylococcus epidermidis and Streptococcus pneumoniae, both of which are resistant to penicillin, the drug resistance rate is 100.00%, the resistance rate of Staphylococcus epidermidis to vancomycin, teicoplanin and amikacin is 0, and the resistance rate of S. pneumoniae to vancomycin and teicoplanin is 0. Conclusion The pathogenic bacteria in the abdominal cavity of the patients with liver cirrhosis are mainly Gram-negative bacteria, and are mainly in E. coli and Klebsiella pneumoniae, and are sensitive to imipenem and meropenem, and can be used as the first choice for clinical application. The clinical should be treated according to the specific drug sensitivity results.
【作者单位】：郑州大学附属肿瘤医院肝胆胰腺外科;河南省肿瘤医院肝胆胰腺外科;郑州大学附属人民医院消毒供应室;河南省人民医院消毒供应室;
【基金】：河南省医学科技攻关计划基金资助项目(201303010)
【分类号】：R446.5;R575.2

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