论文部分内容阅读
目的分析自发性细菌性腹膜炎(SBP)的病原学及耐药特点、实验室特征指标,为早期预警、快速诊断和及时治疗提供客观依据。方法对解放军第三○二医院2011年1月至2013年12月诊断为SBP的1340例住院患者的临床资料及实验室指标进行回顾性分析,对比不同种类病原菌的SBP的分布特点和实验室特征,明确不同种类病原菌的耐药特点。药敏结果采用WHONET5软件进行分析,统计学分析采用CHISS统计软件,计量资料采用t检验,计数资料采用χ2检验。结果 1340例肝硬化合并SBP患者中,感染革兰阴性杆菌(G-b)591例(44.10%),革兰阳性球菌(G+C)746例(55.67%),真菌1例(0.07%)、革兰阳性杆菌(G+b)2例(0.15%)。G-b合并其他部位感染、血中性粒细胞、腹水白细胞数(WBC)、多形核白细胞(PMN)、ALT、AST、TBil、外源性凝血酶原活动度(PTA)、血肌酐(Cr)等实验室指标的异常率,明显高于G+C感染(P<0.05)。大肠杆菌和肺炎克雷伯菌产生超广谱β-内酰胺酶(ESBL)阳性率分别为40.00%和36.03%。鲍曼不动杆菌对阿米卡星、磺胺甲恶唑/甲氧苄啶、亚胺培南耐药率为42.42%、57.57%、57.58%;铜绿假单胞菌对头孢哌酮和替卡西林/克拉维酸耐药率分别为45.45%、36.36%。甲氧西林耐药金黄色葡萄球菌构成比43.33%,甲氧西林耐药凝固酶阴性葡萄球菌构成比78.09%,对万古霉素和替考拉宁的敏感率为100%。结论 SBP的病原菌以G+C和G-b为主,耐药严重,辅助诊断血中性粒细胞、腹水WBC、腹水PMN、ALT、AST、TBil、PTA、Cr可预测G-b感染,治疗应依据感染病原的类型和药敏及患者病情选择抗生素。
Objective To analyze the etiological and drug resistance characteristics and laboratory characteristics of spontaneous bacterial peritonitis (SBP) and provide objective evidence for early warning, rapid diagnosis and timely treatment. Methods The clinical data and laboratory indexes of 1,340 hospitalized patients diagnosed as SBP from January 2011 to December 2013 in People’s Liberation Army Hospital were retrospectively analyzed. The distribution characteristics and laboratory characteristics of different types of pathogens were compared , Clear different types of pathogens resistance characteristics. Drug susceptibility results using WHONET5 software for analysis, statistical analysis using CHISS statistical software, measurement data using t test, count data using χ2 test. Results Among 1340 cirrhotic patients with SBP, 591 (44.10%) were Gram-negative bacilli (Gb), 746 (55.67%) were Gram-positive cocci, one was fungi (0.07%) 2 (0.15%) were positive for Langergebras (G + b). Gb combined with other parts of the infection, blood neutrophils, ascites white blood cell count (WBC), polymorphonuclear leukocytes (PMN), ALT, AST, TBil, exogenous prothrombin activity (PTA), serum creatinine (Cr) And other laboratory abnormalities rate was significantly higher than G + C infection (P <0.05). Escherichia coli and Klebsiella pneumoniae producing extended-spectrum β-lactamase (ESBL) -positive rates were 40.00% and 36.03%. Acinetobacter baumannii amikacin, sulfamethoxazole / trimethoprim, imipenem resistance rates were 42.42%, 57.57%, 57.58%; Pseudomonas aeruginosa cefoperazone and Tika Xilin / clavulanic acid resistance rates were 45.45%, 36.36%. The ratio of methicillin-resistant Staphylococcus aureus was 43.33%, that of methicillin-resistant coagulase-negative Staphylococcus was 78.09%, and that of vancomycin and teicoplanin was 100%. Conclusion The pathogens of SBP are predominantly G + C and Gb, with severe resistance. Assisted diagnosis of Gb infection may be based on the diagnosis of blood neutrophils, ascites WBC, ascites PMN, ALT, AST, TBil, PTA and Cr. The type and drug sensitivity and patient’s condition choose antibiotics.