老年肝硬化并发自发性腹膜炎临床特点及病原学分析

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。

Clinical characteristics and etiological analysis of the elderly liver cirrhosis complicated with spotaneous bacterial peritonitis

Objective To investigate the clinical and etiological characteristics of elderly liver cirrhosis complicated with spotaneous bacterial peritonitis（SBP）,provide guidance for clinically reasonable use of antibiotics. Method Clinical features of elderly cirrhosis with SBP were analyzed retrospectively,and the total 120 strains of pathogens were identified and the drug resistance were analyzed. Result 113 patients among 365 sufferers with SPB had been cured （31.0%）,99 patients getting better （27.1%）,while 153 patients getting worse,including against-advice discharge or dead （41.9%）. Besides,there were 164 cases of attack occultness （44.9%） and 201 cases of acute attack （55.1%）. Pathogens were found in 118 cases,with a positive rate of 32.3%.Totally 120 strains of pathogens were isolated from the 118 ascitic speciments. Escherichia coli was top-rated （48/120,40.0%）,followed by Klebsiella pneumoniae （15/120,12.5%）. The isolated strains were highly resistant to antibacterial agents,especially Escherichia coli,the resistance of which to most antibiotics were above 60%. Conclusion The clinical manifestation of elderly cirrhosis with SBP is complex and the death rate was high. Moreover,pathogenic bacteria have strong drug resistance. Therefore,ascetic cultivation shall be taken as soon as possible. Secondly,the antibiotics shall be reasonably chosen according to the test results of the pathogens＇ sensitivity to drugs.