The clinical and drug sensitivity test analysis in 40 chronic hepatopathy patients with SBP
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摘要: 研究慢性肝病合并自发性腹膜炎临床诊断标准、致病菌分布及抗生素耐药情况 ;选择细菌培养阳性、诊断确切的 4 0例住院患者进行临床资料和抗生素耐药性分析 ;①自发性腹膜炎的临床症状、体征、实验室检查均呈不典型表现 ,诊断应综合分析。②由致病菌和条件致病菌所致者分别占 17 5 %和 82 5 % ,革兰氏阳性和阴性菌分别占 4 7 5 %和 5 2 5 % ,优势菌为大肠杆菌 ,占 35 %。③常用抗生素对常见细菌尚无耐药性的有利福平、头孢氨噻肟、头孢三嗪、头孢拉定、氨曲南 ;氟喹诺酮类抗生素和氧哌嗪青霉素的耐药性明显增加达 30 %~ 4 7 5 % ;但 β内酰胺酶抑制剂的应用可以使 β内酰胺类抗生素的敏感性提高近一倍。④自发性腹膜炎中可能存在MRSA和MRSE ,对去甲万古霉素高度敏感。大部分葡萄球菌对第一代头孢菌素、氨基糖甙类抗生素仍敏感。应严密观察抗菌素的耐药性变化 ,合理使用抗生素 ,非MRSA、MRSE不应滥用万古霉素。Abstract: To research the clinical diagnosis standard, type of pathogens and antibiotics resistance in chronic hepatopathy patients with SBP. The clinical data and drug resistancce of 40 chronic hepatopathy with SBP, which had positive ascites culture results, were analyzed. ① The clinical symptoms, signs and laboratory findings are atypical. ② The percentage of pathogens is as the following disease-producing pathogen accounts for 17 5%, opportanistic pathogen 82 5%. Gram-positive bacillis occupies 47 5%. Gram-negative bacillis occupies 52 5%. The predominant strain is E. coli (35%) . ③Rifampicinum, cefotaxime, ceftriaxone, cefradine and agtreonam are rarely drug-resistant. The risistance to Quinolone kind and piperacillin increse significantly (30-47 5%) . The induction of β-lactamase inhibitor nearly doubles the sesitivity to β-lactams. ④MRSA and MRSE are highly sensitive to demetlyl-vancomycine. Most of staphylococcus in still sesentive to the generation cephalosporines and aminoglycosides. To use antibiotics more reasonably, the resistance of bacteria should be closely monitored, vancomycine should not be abused if the pathogen is not MRSA or MRSE.
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Key words:
- chronic hapatopathy /
- spontaneous peritonitis /
- drug-resistantgerm
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