Li Yong-Tao, Yu Cheng-Bo, Huang Jian-Rong, Qin Zheng-Ji, Li Lan-Juan
Yong-Tao Li, Cheng-Bo Yu, Jian-Rong Huang, Lan-Juan Li, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China.
World J Gastroenterol. 2015 Sep 28;21(36):10409-17. doi: 10.3748/wjg.v21.i36.10409.
To investigate the microbiological characteristics and drug resistance in liver cirrhosis patients with spontaneous peritonitis.
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.
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 β-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).
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.
探讨肝硬化自发性腹膜炎患者的微生物学特征及耐药性。
分析2011年1月至2013年12月浙江大学第一附属医院肝硬化合并腹部感染患者的数据。鉴定腹水中存在的病原体，并测定其对各种抗生素的敏感性。
从288例患者中分离出306株病原菌：178例感染由革兰阴性菌引起（58.2%）；85例由革兰阳性菌引起（27.8%）；9例由真菌引起（2.9%）；16例由一种以上病原体引起。主要病原体为大肠埃希菌（24.2%）、肺炎克雷伯菌（18.9%）、肠球菌属（11.1%）和金黄色葡萄球菌（7.5%）。在分离出的306株病原体中，99株引起医院感染，207株引起社区获得性感染和其他感染。医院感染的大肠埃希菌和肺炎克雷伯菌菌株产生超广谱β-内酰胺酶的比例高于非医院感染（分别为62.5%对38%，P<0.013；36.8%对12.8%，P<0.034）。医院感染和非医院感染对个别抗生素的敏感性不同：哌拉西林/他唑巴坦对非医院感染的大肠埃希菌感染疗效显著更高（4%对20.8%，P<0.021）。呋喃妥因对引起非医院感染的肠球菌属抗菌活性更强（36.4%对86.3%，P<0.009）。
肝硬化患者腹部感染的病原体多数为革兰阴性菌，医院感染的耐药性显著高于非医院感染。
