三代头孢菌素耐药性自发性细菌性腹膜炎：单中心经验和现有研究综述。
Third-generation cephalosporin-resistant spontaneous bacterial peritonitis: a single-centre experience and summary of existing studies.
出版信息
Can J Gastroenterol Hepatol. 2014 Feb;28(2):83-8. doi: 10.1155/2014/429536. Epub 2013 Nov 28.
BACKGROUND
Spontaneous bacterial peritonitis (SBP) is the most prevalent bacterial infection in patients with cirrhosis. Although studies from Europe have reported significant rates of resistance to third-generation cephalosporins, there are limited SBP-specific data from centres in North America.
OBJECTIVE
To evaluate the prevalence of, predictors for and clinical impact of third-generation cephalosporin-resistant SBP at a Canadian tertiary care centre, and to summarize the data in the context of the existing literature.
METHODS
SBP patients treated with both antibiotics and albumin therapy at a Canadian tertiary care hospital between 2003 and 2011 were retrospectively identified. Multivariate logistic regression was used to determine independent predictors of third-generation cephalosporin resistance and mortality.
RESULTS
In 192 patients, 25% of infections were nosocomial. Forty per cent (77 of 192) of infections were culture positive; of these, 19% (15 of 77) were resistant to third-generation cephalosporins. The prevalence of cephalosporin resistance was 8% with community-acquired infections, 17% with health care-associated infections and 41% with nosocomial acquisition. Nosocomial acquisition of infection was the only predictor of resistance to third-generation cephalosporins (OR 4.0 [95% CI 1.04 to 15.2]). Thirty-day mortality censored for liver transplantation was 27% (50 of 184). In the 77 culture-positive patients, resistance to third-generation cephalosporins (OR 5.3 [1.3 to 22]) and the Model for End-stage Live Disease score (OR 1.14 [1.04 to 1.24]) were independent predictors of 30-day mortality.
CONCLUSIONS
Third-generation cephalosporin-resistant SBP is a common diagnosis and has an effect on clinical outcomes. In an attempt to reduce the mortality associated with resistance to empirical therapy, high-risk subgroups should receive broader empirical antibiotic coverage.
背景
自发性细菌性腹膜炎（SBP）是肝硬化患者最常见的细菌性感染。尽管来自欧洲的研究报告称第三代头孢菌素的耐药率很高，但北美的中心很少有 SBP 特异性数据。
目的
评估加拿大一家三级保健中心第三代头孢菌素耐药性 SBP 的流行率、预测因素和临床影响，并结合现有文献总结数据。
方法
对 2003 年至 2011 年在加拿大一家三级保健医院接受抗生素和白蛋白治疗的 SBP 患者进行回顾性分析。采用多变量逻辑回归确定第三代头孢菌素耐药和死亡率的独立预测因素。
结果
在 192 例患者中，25%的感染为医院获得性。40%（192 例中的 77 例）的感染培养阳性；其中，19%（77 例中的 15 例）对第三代头孢菌素耐药。社区获得性感染的头孢菌素耐药率为 8%，医源性感染为 17%，医院获得性感染为 41%。医院获得性感染是对第三代头孢菌素耐药的唯一预测因素（OR 4.0[95%CI 1.04 至 15.2]）。30 天死亡率因肝移植而被删失为 27%（184 例中的 50 例）。在 77 例培养阳性的患者中，对第三代头孢菌素的耐药性（OR 5.3[1.3 至 22]）和终末期肝病模型评分（OR 1.14[1.04 至 1.24]）是 30 天死亡率的独立预测因素。
结论
第三代头孢菌素耐药性 SBP 是一种常见的诊断，对临床结果有影响。为了降低耐药性治疗相关死亡率，高危亚组应接受更广泛的经验性抗生素覆盖。
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