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目的研究肝硬化患者自发性细菌腹膜炎细菌学。方法对自发性细菌腹膜炎的肝硬化患者进行腹水的病原菌培养和药敏试验,同时进行ESBLs的检测。结果腹水培养阳性率低,腹水感染中主要是革兰阴性菌,提示首选的药物包括碳青霉烯类的亚胺培南和β-内酰胺类抗生素与β-内酰胺酶抑制剂合剂。结论肝硬化伴自发性细菌性腹膜炎的主要细菌是大肠埃希菌,其对抗生素耐药的主要原因是ESBLs。临床上对治疗此类患者需及时进行腹水的病原菌培养和药敏试验,同时进行ESBLs的检测,指导临床合理应用抗生素,是决定SBP患者疗效的关键。
Objective To study the bacteriology of spontaneous bacterial peritonitis in patients with cirrhosis. Methods Pathogens culture and drug susceptibility testing of ascites were performed in cirrhotic patients with spontaneous bacterial peritonitis. ESBLs were also detected. Results The positive rate of ascites culture was low. Gram-negative bacteria were mainly found in ascites infection, suggesting that the preferred drugs include carbapenem imipenem and β-lactam antibiotics combined with β-lactamase inhibitors. Conclusions The main bacterium of cirrhosis with spontaneous bacterial peritonitis is Escherichia coli. The main reason of resistance to antibiotics is ESBLs. Clinically for the treatment of such patients need timely pathogen culture of ascites and drug susceptibility testing, while ESBLs detection, clinical rational use of antibiotics, is to determine the key to the efficacy of SBP patients.