Tu Bo, Zhang Yuening, Bi Jingfeng, Xu Zhe, Shi Lei, Zhang Xin, Zhao Peng, Zhang Dawei, Yang Guang, Qin Enqiang
Department of Infectious disease, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
Bo Tu, Yuening Zhang, and Jingfeng Bi contributed equally to this work.
Infect Microbes Dis. 2020 Aug 7;2(4):167-172. doi: 10.1097/IM9.0000000000000035. eCollection 2020 Dec.
is a prevalent causative pathogen of spontaneous bacterial peritonitis (SBP). In this retrospective study, we investigated the microbiological characteristics and antibiotic susceptibility of clinical isolates obtained from liver cirrhosis patients suffering from nosocomial SBP. Our results showed that extended-spectrum β-lactamase (ESBL)-producing accounted for 47% of the cases, while 62% of the isolates were multi-drug resistant (MDR) pathogens. ESBL-producing and MDR isolates showed high incidences of resistance to third-generation cephalosporins, but they displayed susceptibility to carbapenems, β-lactamase inhibitors, and aminoglycosides. Importantly, liver cirrhosis patients with MDR SBP showed a significantly higher death rate than patients with non-MDR infections ( = 0.021). The 30-day mortality of nosocomial SBP was independently correlated with female gender [odds ratio (OR) = 5.200, 95% confidence interval (CI) = 1.194-22.642], liver failure (OR = 9.609, 95% CI = 1.914-48.225), hepatocellular carcinoma (OR = 8.176, 95% CI = 2.065-32.364), hepatic encephalopathy (OR = 8.176, 95% CI = 2.065-32.364), model of end-stage liver disease score (OR = 1.191, 95% CI = 1.053-1.346), white blood cell count (OR = 0.847, 95% CI = 0.737-0.973), and ascites polymorphonuclear (OR = 95.903, 95% CI = 3.410-2697.356). In conclusion, third-generation cephalosporins may be inappropriate for empiric treatment of nosocomial SBP caused by , due to the widespread presence of ESBLs and high incidence of MDR pathogens.
是自发性细菌性腹膜炎（SBP）的常见致病病原体。在这项回顾性研究中，我们调查了从患有医院获得性SBP的肝硬化患者中分离出的临床菌株的微生物学特征和抗生素敏感性。我们的结果显示，产超广谱β-内酰胺酶（ESBL）的菌株占病例的47%，而62%的分离株为多重耐药（MDR）病原体。产ESBL和MDR的分离株对第三代头孢菌素的耐药率很高，但它们对碳青霉烯类、β-内酰胺酶抑制剂和氨基糖苷类敏感。重要的是，患有MDR SBP的肝硬化患者的死亡率显著高于非MDR感染患者（P = 0.021）。医院获得性SBP的30天死亡率与女性性别[比值比（OR）= 5.200，95%置信区间（CI）= 1.194 - 22.642]、肝衰竭（OR = 9.609，95% CI = 1.914 - 48.225）、肝细胞癌（OR = 8.176，95% CI = 2.065 - 32.364）、肝性脑病（OR = 8.176，95% CI = 2.065 - 32.364）、终末期肝病模型评分（OR = 1.191，95% CI = 1.053 - 1.346）、白细胞计数（OR = 0.847，95% CI = 0.737 - 0.973）和腹水多形核细胞（OR = 95.903，95% CI = 3.410 - 2697.356）独立相关。总之，由于ESBL的广泛存在和MDR病原体的高发生率，第三代头孢菌素可能不适用于经验性治疗由该病原体引起的医院获得性SBP。
