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目的探讨老年肝硬化并发自发性腹膜炎(SBP)患者的临床特点及腹水病原菌分布及其耐药情况,指导临床合理用药。方法回顾性分析老年肝硬化并发SBP患者的临床特点,并对118例腹水病原菌培养结果阳性的120株病原菌进行鉴定和耐药分析。结果365例SPB患者治愈113例(31.0%),好转99例(27.1%),病情恶化自动出院及死亡153例(41.9%)。发病隐匿164例(44.9%),急性发病201例(55.1%)。365例SBP患者腹水病原菌培养阳性118例(32.3%),共分离出病原菌120株,其中大肠埃希菌检出率最高,占40.0%(48/120),其次为肺炎克雷伯菌,占12.5%(15/120)。分离菌株的耐药情况比较严重,特别是大肠埃希菌对多种抗菌药物的耐药率>60%。结论老年肝硬化并发SBP患者病情复杂,病死率高,且细菌耐药比较严重,应尽早进行腹水培养,依据药物敏感试验结果合理选用抗菌药物。
Objective To investigate the clinical characteristics of patients with senile cirrhosis complicated by spontaneous peritonitis (SBP) and the distribution and drug resistance of ascites pathogens to guide clinical rational use of drugs. Methods The clinical features of elderly patients with cirrhosis complicated with SBP were analyzed retrospectively. 120 strains of pathogenic bacteria with ascites pathogens were identified and resistant. Results A total of 365 cases of SPB were cured (31.0%), 99 cases (27.1%) were cured, 153 cases (41.9%) were discharged and died automatically. Incidence of occult 164 cases (44.9%), acute onset in 201 cases (55.1%). Of the 365 SBP patients, 118 (32.3%) were positive for ascites pathogens, of which 120 strains were isolated. The highest detection rate of Escherichia coli was 40.0% (48/120), followed by Klebsiella pneumoniae 12.5% (15/120). Resistant strains isolated strains more serious, especially E. coli resistance to a variety of antimicrobial drugs> 60%. Conclusions Patients with cirrhosis of the liver complicated with SBP are more complicated and have a higher case fatality rate and severe bacterial resistance. Ascitic fluid culture should be carried out as soon as possible, and antibiotics should be selected according to the result of drug sensitivity test.