Distribution of strain of ascitic pathogens and changes of sensitiveness to antibacterials in patients with spontaneous peritonitis
10.3760/cma.j.issn.1008-5734.2017.02.003
- VernacularTitle:自发性细菌性腹膜炎患者腹水分离病原菌的菌种分布及对抗菌药物敏感性的变化
- Author:
Junfu ZHENG
1
;
Yan DANG
;
Yanhua YU
;
Lei LI
;
Jinli LOU
;
Huiguo DING
Author Information
1. 100069,首都医科大学附属北京佑安医院肝病消化中心
- Publication Type:Journal Article
- Keywords:
Peritonitis;
Bacterial infections;
Drug resistance
- From:
Adverse Drug Reactions Journal
2017;19(2):89-95
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the strain distribution of ascitic pathogens in patients with spontaneous bacterial peritonitis (SBP) and the changes of sensitiveness to antibacterials from 2009 to 2016.Methods The medical records of SBP patients who were hospitalized in Beijing Youan Hospital from 2009 to 2016 were collected.The results of ascites bacterial culture of SBP patients were all positive.The results of ascites culture, pathogen identification, and the drug sensitivity test were recorded.The changes of distribution of ascitic pathogens and the sensitiveness to antibacterials were analyzed according to the time interval of every two years.Results A total of 1 107 SBP patients were enrolled in the study.Of them, 816 patients were male with average age (54±10) years, 291 patients were female with average age (57±13) years.There were 1 042(94.1%) patients with positive bacterial culture of ascites and 65 patients (5.9%) with positive fungal culture of ascites among the 1 107 patients, respectively.There were 920(83.11%) patients with end-stage liver disease, 113 (10.2%) with biliary tract disease, and 74(6.68%) with other diseases in the 1 107 patients.A total of 1 441 strains of pathogenic bacteria were identified, comprised of gram negative (G-) bacteria 637 (44.2%) strains, gram positive (G+) bacteria 739(51.3%) strains, and fungi 65(4.5%) strains.During 2009 to 2016, the top four number of strains of G-bacteria in SBP patients'ascites from high to low were Escherichia coli [213(14.8%)], Klebsiella pneumoniae [146 (10.1%)], Pseudomonas aeruginosa[52(3.6%)] and Enterobacter cloacae[38(2.6%)];the top four strains of G(+) bacteria were Enterococcus faecium[176(12.2%)], Staphylococcus epidermidis[132(9.1%)], Staphylococcus haemolyticus [130(9.0%)] and Enterococcus faecalis [75(5.2%)];and the top 2 of fungi in SBP patients' ascites were Candida albicans[36(2.5%)] and Candida glabrata[12(0.8%)].Compared with the time interval of 2009-2010, the constituent ratio of G(-) bacteria in 2015-2016 was decreased significantly [49.3%(73/148)vs.39.4% (196/498), P=0.031] , the constituent rate of fungi was increased significantly [6.4%(32/498) vs.2.0% 3/148), P=0.038].There were no statistical significance in G(+) bacteria's constituent ratio among different time intervals.The constituent rate of extended spectrum beta-lactamases (ESBL) in Escherichia coli was higher in the time interval of 2015-2016 than that in the time interval of 2009-2010 [57.4% (35/61) vs.32% (8/25), P=0.033].The drug resistance of Escherichia coli to imipenem and meropenem were increased significantly during the same period (P=0.026, P=0.025).The results of drug sensitivity tests showed that G(-) bacteria was sensitive to imipenem, meropenem, amikacin and piperacillin/tazobactam;G(+) bacteria was sensitive to linezolid, teicoplanin and vancomycin.Conclusions The distribution of ascitic pathogens in SBP patients who were hospitalized in Beijing Youan Hospital from 2009 to 2016 present the tendency of decreasing of G(-) bacteria and increasing of fungi.The main pathogenic bacteria of SBP are drug-resistant.The resistance rates of Escherichia coli to imipenem, meropenem and cefotaxime have increased year by year.
