Nosocomial and community-acquired spontaneous bacterial peritonitis in patients with liver cirrhosis:bacteriology and antibiotic resistance
10.3760/cma.j.issn.1000-6680.2010.10.009
- VernacularTitle:肝硬化合并自发性细菌性腹膜炎医院感染及社区感染病原学研究
- Author:
Yuying YANG
;
Xinghong LI
;
Huizhu WANG
- Publication Type:Journal Article
- Keywords:
Cross infection;
Peritonitis;
Liver cirrhosis;
Escherichia coli;
Klebsiella pneumoniae;
Drug resistance,becterial
- From:
Chinese Journal of Infectious Diseases
2010;28(10):611-614
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the pathogenic features and antibiotic resistance profile of nosocomial and community-acquired spontaneous bacterial peritonitis (SBP) in liver cirrhosis patients.Methods Two hundred and twenty-six cirrhotic patients with SBP who were admitted to Beijin Ditan Hospital from January 2001 to December 2008 were recruited into this study. The bacterial identification and drug susceptibility were performed. The data were analyzed by Chi square test and t test. Results Eighty-six(38.0% ) patients were diagnosed with nosocomial SBP and 140 (62.0%)were diagnosed with community-acquired SBP. The proportion of Child-Pugh Class C cases in patients with nosocomial SBP was higher than patients with community acquired SBP (97.7% vs. 82.8%; x2= 11. 489, P=0.001). Mortality rate in patients with nosocomiat SBP was also higher than patients with community acquired SBP (50. 0% vs. 30. 0%; x2 =9. 081,P=0. 003). Total 28 species (232strains) of bacteria were isolated from these patients. 77.5 % (69/89) of the nosomial SBP cases and 76.9% (110/143) of community-acquired SBP cases were caused by Gram-negative bacteria (mainly were Escherichia coli and Klebsiella pneumoniae). 19.1% nosocomial SBP cases and 21. 8%community-acquired SBP cases were caused by Gram-positive bacteria. Fungus infections accounted for 3.4% and 1.4% of these two population, respectively(P＞0.05). In patients with nosocomial SBP,19 out of 32 Escherichia coli stains and 5 out of 14 Klebsiella pneunmoniae strains were extended spectrum β-lactamase (ESBL) positive, while among 60 Escherichia coli stains and 32 Klebsiella pneunmoniae strains, only 11 Escherichia coli stains were ESBL positive (P＜0.05). The resistance rates of Gram-negative strains to cephalosporin and quinolone in nosocomial SBP patients were both higher than those in community-acquired SBP patients(P＜0. 05), but all Gram-negative isolates were sensitive to imipenem (P＞ 0. 05). No Gram-positive isolates resistant to vancomycin were found.Conclusions The liver cirrhosis patients with Child-Pugh Class C are vulnerable to nosocomial SBP and the prognosis is poor. Although the pathogenic spectrum are similar in cirrhotic patients with nosocomial and community-acquired SBP, which mainly are Escherichia coli and Klebsiella pneumoniae, the percentage of ESBL producing strains is higher in nosocomial SBP patients compared to that in community-acquired SBP patients.
