2nd Department of Medicine, University of Athens Medical School, Athens, Greece.
Liver Int. 2013 Aug;33(7):975-81. doi: 10.1111/liv.12152. Epub 2013 Mar 24.
Spontaneous bacterial peritonitis (SBP) is historically caused by Gram-negative bacteria (GNB) almost exclusively Enterobacteriaceae. Recently, an increasing rate of infections with Gram-positive cocci (GPC) and multidrug-resistant (MDR) microorganisms was demonstrated.
To assess possible recent changes of the bacteria causing SBP in cirrhotic patients.
We retrospectively recorded 47 cases (66% males) during a 4-year-period (2008-2011).
Twenty-eight (60%) patients had healthcare-associated infections while 15 (32%) received prophylactic quinolone treatment. GPC were found to be the most frequent cause (55%). The most prevalent organisms in a descending order were Streptococcus spp (n = 10), Enterococcus spp (n = 9), Escherichia coli (n = 8), Klebsiella pneumonia (n = 5), methicillin-sensitive Staphylococcus aureus (n = 4) and coagulase-negative Staphylococcus spp (n = 3). Nine of the isolated bacteria (19%) were MDR, including carbapenemase-producing K. pneumonia (n = 4), followed by extended-spectrum beta-lactamase-producing E. coli (n = 3) and Pseudomonas aeruginosa (n = 2). MDR bacteria were more frequently isolated in healthcare-associated than in community-acquired infections (100% vs 50%, P = 0.006), in patients receiving long-term quinolone prophylaxis (67% vs 24%, P = 0.013) and in those with advanced liver disease as suggested by higher MELD score (28 vs 19, P = 0.012). More infections with GNB than GPC were healthcare-associated (81% vs 42%, P = 0.007). Third-generation cephalosporin resistance was observed in 49% and quinolone resistance in 47%.
GPC were the most frequent bacteria in culture-positive SBP and a variety of drug-resistant microorganisms have emerged. As a result of high rates of resistance in currently recommended therapy and prophylaxis, the choice of optimal antibiotic therapy is vital in the individual patient.
自发性细菌性腹膜炎（SBP）历史上几乎完全由革兰氏阴性菌（GNB）引起，主要为肠杆菌科。最近，革兰氏阳性球菌（GPC）和多重耐药（MDR）微生物引起感染的比例不断增加。
评估肝硬化患者发生 SBP 的致病菌是否有近期变化。
我们回顾性记录了 4 年间（2008-2011 年）的 47 例病例（66%为男性）。
28 例（60%）患者有医源性感染，15 例（32%）接受预防性喹诺酮治疗。GPC 是最常见的原因（55%）。依次为最常见的病原体：链球菌属（n = 10）、肠球菌属（n = 9）、大肠杆菌（n = 8）、肺炎克雷伯菌（n = 5）、甲氧西林敏感金黄色葡萄球菌（n = 4）和凝固酶阴性葡萄球菌属（n = 3）。9 株分离菌（19%）为 MDR，包括产碳青霉烯酶肺炎克雷伯菌（n = 4），其次为产超广谱β-内酰胺酶大肠杆菌（n = 3）和铜绿假单胞菌（n = 2）。医源性感染比社区获得性感染更常分离出 MDR 细菌（100% vs 50%，P = 0.006），长期接受喹诺酮类预防性治疗的患者（67% vs 24%，P = 0.013）和 MELD 评分较高（28 分 vs 19 分，P = 0.012）提示肝病更严重的患者。与 GPC 相比，GNB 感染更常见于医源性感染（81% vs 42%，P = 0.007）。第三代头孢菌素耐药率为 49%，喹诺酮耐药率为 47%。
在培养阳性的 SBP 中，GPC 是最常见的细菌，出现了多种耐药微生物。由于目前推荐的治疗和预防方案中耐药率较高，在个体患者中选择最佳抗生素治疗方案至关重要。
