Cheong Hae Suk, Kang Cheol-In, Lee Jeong A, Moon Soo Youn, Joung Mi Kyong, Chung Doo Ryeon, Koh Kwang Cheol, Lee Nam Yong, Song Jae-Hoon, Peck Kyong Ran
Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Clin Infect Dis. 2009 May 1;48(9):1230-6. doi: 10.1086/597585.
There have been few reports on the causes and treatment outcomes for nosocomial spontaneous bacterial peritonitis (SBP) in patients with liver cirrhosis.
We performed a retrospective cohort study to compare the microbiological and clinical characteristics in nosocomial versus community-acquired SBP. All patients with SBP, for whom culture was proven to be positive for SBP at Samsung Medical Center (Seoul, Republic of Korea) from 1 January 2000 through 31 June 2007, were included. Medical records and laboratory data were reviewed. Nosocomial SBP was defined as SBP diagnosed after 72 h of hospitalization.
A total of 236 patients with SBP were enrolled (mean age +/- SD age, 56.6 +/- 10.7 years); 166 patients were women, and 70 were men. Nosocomial and community-acquired SBP occurred in 126 and 110 patients, respectively. Escherichia coli accounted for 102 (43.2%) of 236 isolates, Klebsiella species accounted for 33 isolates (14.0%), and Streptococcus species accounted for 23 isolates (9.8%). The overall 30-day mortality rate for nosocomial SBP was higher than that for community-acquired SBP (58.7% vs. 37.3%; P = .001). Nosocomial isolates of gram-negative organisms were significantly more resistant to third-generation cephalosporins (41% vs. 10.0%; P = .001) and quinolones (50.0% vs. 30.9%; P = .003), compared with community-acquired isolates. Multivariate analysis revealed that nosocomial infection, concomitant hepatocellular carcinoma, presentation with acute renal failure or shock, and resistance to third-generation cephalosporins were significant risk factors for 30-day mortality associated with SBP.
Nosocomial SBP has a poorer outcome than community-acquired SBP. The resistance to third-generation cephalosporins for gram-negative organisms, which are more common in nosocomial cases of SBP than in community-acquired cases of SBP, adversely affects the outcome of SBP in patients with liver cirrhosis.
关于肝硬化患者医院获得性自发性细菌性腹膜炎（SBP）的病因及治疗结果的报道较少。
我们进行了一项回顾性队列研究，以比较医院获得性与社区获得性SBP的微生物学和临床特征。纳入2000年1月1日至2007年6月31日在三星医疗中心（韩国首尔）确诊为SBP且培养结果呈阳性的所有患者。回顾病历和实验室数据。医院获得性SBP定义为住院72小时后诊断的SBP。
共纳入236例SBP患者（平均年龄±标准差年龄，56.6±10.7岁）；女性166例，男性70例。医院获得性和社区获得性SBP分别发生在126例和110例患者中。236株分离菌中，大肠杆菌占102株（43.2%），克雷伯菌属占33株（14.0%），链球菌属占23株（9.8%）。医院获得性SBP的30天总体死亡率高于社区获得性SBP（58.7%对37.3%；P = 0.001）。与社区获得性分离菌相比，医院获得性革兰阴性菌分离株对第三代头孢菌素（41%对10.0%；P = 0.001）和喹诺酮类药物（50.0%对30.9%；P = 0.003）的耐药性明显更高。多变量分析显示，医院感染、合并肝细胞癌、出现急性肾衰竭或休克以及对第三代头孢菌素耐药是与SBP相关的30天死亡率的显著危险因素。
医院获得性SBP的预后比社区获得性SBP差。革兰阴性菌对第三代头孢菌素的耐药性在医院获得性SBP病例中比社区获得性SBP病例中更常见，这对肝硬化患者SBP的预后产生不利影响。
