42例肝硬化腹水并发自发性细菌性腹膜炎病原菌的耐药情况分析

    Clinical observation and analysis of the drug resistance of peritonitis pathogens of 42 cases with ascitesduetocirrhosis

    • 摘要: 目的:了解肝硬化腹水并发自发性细菌性腹膜炎(SBP)患者的临床特征、腹水病原菌分布及药敏情况,为临床早期诊断和合理应用抗生素提供依据。方法:选取42例诊断为SBP且腹水细菌培养阳性的患者为研究对象,分析患者的临床症状、体征、腹水实验室检查及疾病的转归。结果:42例患者有不同程度的发热、腹痛及腹膜刺激征,71%的患者腹水常规检查白细胞500106/L,86%的患者腹水乳酸脱氢酶200 U/L。83.3%的患者腹水细菌培养为革兰阴性菌,以大肠埃希菌为主,其次为肺炎克雷伯杆菌,二者对第三代头孢菌素耐药率均较高。结论:SBP临床表现复杂多样,需充分结合患者的症状、体征及实验室检查,并尽早进行腹水床边培养。治疗上临床怀疑SBP时可先应用第三代头孢加-内酰胺酶抑制剂,待细菌培养药敏结果报告后及时调整。

       

      Abstract: Objective:To understand the clinical characters, the distribution and drug resistance of peritonitis pathogens of cases with ascitesduetocirrhosis and provide the basis of early diagnosis and rational use drug for clinic. Methods:Forty-two cases with spontaneous bacterial peritonitis(SBP) and positive ascites germiculture were selected. The clinical symptoms and signs, and the ascites laboratory results and treatment and disease outcome of all cases were restrospectively analyzed. Results:The different degrees of fever, abdominal pain and peritoneum stimulation were demonstrated in 42 cases. The counts of white blood cells 500 106/Lin 71% and LDH 200 U/L in 86% of cases were detected. Gram-negative bacterium were found in 83. 3% of all cases, which were Escherichia coli, followed by klebsiella pneumonia and had the higher resistance to the third generation cephalosporins antibiotic. Conclusions:The culture of ascites and fully combining the symptoms, signs and laboratory check of patient need be implemented as early as possible because of the diverse and complex clinical manifestations of SBP. The third generation of cephalosporins antibiotics with -lactamase inhibitors need be firstly used for SBP, and drug can be adjusted according to the results of bacteria cultivation in time.

       

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