肝硬化患者自发性细菌性腹膜炎的病原体和转归：社区获得性感染与医院获得性感染。
Causative agents and outcome of spontaneous bacterial peritonitis in cirrhotic patients: community-acquired versus nosocomial infections.
机构信息
Department of Clinical Laboratory, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China.
出版信息
BMC Infect Dis. 2019 May 23;19(1):463. doi: 10.1186/s12879-019-4102-4.
BACKGROUND
Spontaneous bacterial peritonitis (SBP) is a serious complication and common cause of death in patients with liver cirrhosis. This study was conducted to compare the microbiological characteristics, drug resistance, and treatment outcomes for nosocomial SBP and community-acquired SBP.
METHODS
A retrospective study was performed on 334 patients with culture-positive SBP at Beijing Youan Hospital, China, between January 2012 and December 2016. The medical records for these patients were reviewed, and their clinical and laboratory data were analyzed.
RESULTS
A total of 155 (46.4%) patients with nosocomial SBP and 179 (53.6%) with community-acquired SBP were included in this study. From the patients' ascitic fluids, 334 pathogenic strains, including 178 Gram-negative bacterial strains, 138 Gram-positive bacterial strains and 18 other microbial strains were isolated. E. coli was the major pathogen (24.3%), followed by Klebsiella pneumoniae (12.0%) and Enterococcus faecium (10.5%). The proportion of Enterococcus was significantly higher in the patients with nosocomial SBP (6.1% vs. 27.7%, P < 0.001) than in the patients with community-acquired SBP. The main pathogens isolated from the nosocomial infections were significantly more resistant to the first-line recommended drug. Compared with community-acquired SBP, nosocomial SBP had a poorer outcome (36.8% vs. 24.6%; P = 0.016). The independent predictors for 30-day mortality included nosocomial infection, Child-Pugh classification, hepatocellular carcinoma, renal failure and hepatic encephalopathy.
CONCLUSION
Gram-negative bacteria were the major pathogens involved in SBP in the cirrhotic patients. The strains isolated from the patients with nosocomial SBP displayed higher drug resistance than those isolated from patients with community-acquired SBP. Compared with community-acquired SBP, nosocomial SBP had a poorer outcome. When choosing drug treatments, the acquisition site of infection and the local epidemiological situation should be taken into account.
背景
自发性细菌性腹膜炎（SBP）是肝硬化患者的一种严重并发症和常见死因。本研究旨在比较医院获得性 SBP 和社区获得性 SBP 的微生物学特征、耐药性和治疗结果。
方法
对 2012 年 1 月至 2016 年 12 月期间在中国北京佑安医院收治的 334 例培养阳性 SBP 患者进行回顾性研究。分析了这些患者的临床和实验室数据。
结果
本研究共纳入 155 例（46.4%）医院获得性 SBP 患者和 179 例（53.6%）社区获得性 SBP 患者。从患者的腹水中共分离出 334 株病原菌，包括 178 株革兰氏阴性菌、138 株革兰氏阳性菌和 18 株其他微生物菌株。大肠埃希菌是主要病原体（24.3%），其次是肺炎克雷伯菌（12.0%）和屎肠球菌（10.5%）。医院感染患者肠球菌的比例明显高于社区获得性 SBP 患者（6.1% vs. 27.7%，P < 0.001）。医院感染分离的主要病原体对一线推荐药物的耐药性明显更高。与社区获得性 SBP 相比，医院获得性 SBP 的预后较差（36.8% vs. 24.6%；P = 0.016）。30 天死亡率的独立预测因素包括医院感染、Child-Pugh 分级、肝细胞癌、肾衰竭和肝性脑病。
结论
革兰氏阴性菌是肝硬化患者 SBP 的主要病原体。医院获得性 SBP 患者分离的菌株比社区获得性 SBP 患者分离的菌株耐药性更高。与社区获得性 SBP 相比，医院获得性 SBP 的预后较差。在选择药物治疗时，应考虑感染部位和当地的流行病学情况。
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