Abstract：
The microbial spectrum and antimicrobial resistance patterns change over time and vary across regions in patients with spontaneous bacterial peritonitis (SBP). There is an urgent need to clarify the factors associated with in-hospital mortality in these patients.
In this study, 377 patients with SBP and 794 patients with bacterascites were analyzed for the microbial spectrum, antimicrobial resistance profiles, and laboratory findings.
The most common pathogens were Escherichia coli (96, 25.5%), Staphylococcus epidermidis (55, 14.6%), and Enterococcus faecium (42, 11.1%). Multidrug-resistant (MDR) bacteria comprised 49.7% of gram-positive bacteria (GPB) and 48.8% of gram-negative bacteria (GNB). The most sensitive antibiotics were amikacin (91.5%), meropenem (89.8%) and piperacillin/tazobactam (87.6%). Extensively drug-resistant (XDR) (OR=51.457, p < 0.001), neutrophil count (OR=1.088, p < 0.001), and the model for end-stage liver disease (MELD) score (OR=1.124, p < 0.001) were independent predictive factors of in-hospital mortality in patients with SBP.
MDR represented nearly half of the bacteria isolated from patients with SBP, of which the high prevalence of extended-spectrum β-lactamase-producing and Carbapenem-resistant bacteria is concerning. The presence of XDR, higher MELD score, and neutrophil count were independent predictive factors associated with higher in-hospital mortality in patients with SBP, indicating that intensive care should be provided to these patients.
In this study, 377 patients with SBP and 794 patients with bacterascites were analyzed for the microbial spectrum, antimicrobial resistance profiles, and laboratory findings.
The most common pathogens were Escherichia coli (96, 25.5%), Staphylococcus epidermidis (55, 14.6%), and Enterococcus faecium (42, 11.1%). Multidrug-resistant (MDR) bacteria comprised 49.7% of gram-positive bacteria (GPB) and 48.8% of gram-negative bacteria (GNB). The most sensitive antibiotics were amikacin (91.5%), meropenem (89.8%) and piperacillin/tazobactam (87.6%). Extensively drug-resistant (XDR) (OR=51.457, p < 0.001), neutrophil count (OR=1.088, p < 0.001), and the model for end-stage liver disease (MELD) score (OR=1.124, p < 0.001) were independent predictive factors of in-hospital mortality in patients with SBP.
MDR represented nearly half of the bacteria isolated from patients with SBP, of which the high prevalence of extended-spectrum β-lactamase-producing and Carbapenem-resistant bacteria is concerning. The presence of XDR, higher MELD score, and neutrophil count were independent predictive factors associated with higher in-hospital mortality in patients with SBP, indicating that intensive care should be provided to these patients.
摘要：
目的：自发性细菌性腹膜炎（SBP）患者的微生物谱和抗菌药物耐药模式随着时间的推移而变化，并因地区而异。迫切需要澄清与这些患者住院死亡率相关的因素。
方法：在本研究中，对377例SBP患者和794例腹水患者进行微生物谱分析，抗菌素耐药性概况，和实验室发现。
结果：最常见的病原体是大肠杆菌（96，25.5％），表皮葡萄球菌（55，14.6%），和屎肠球菌（42，11.1%）。多药耐药（MDR）细菌占49.7％的革兰氏阳性菌（GPB）和48.8％的革兰氏阴性菌（GNB）。最敏感的抗生素是阿米卡星（91.5%），美罗培南(89.8%)和哌拉西林/他唑巴坦(87.6%)。广泛耐药（XDR）（OR=51.457，p<0.001），中性粒细胞计数（OR=1.088，p<0.001），终末期肝病模型（MELD）评分（OR=1.124，p<0.001）是SBP患者住院死亡率的独立预测因素。
结论：MDR占SBP患者分离出的细菌的近一半，其中，产超广谱β-内酰胺酶和耐碳青霉烯类细菌的高患病率令人担忧。XDR的存在，较高的MELD分数，和中性粒细胞计数是SBP患者院内死亡率较高的独立预测因素,表明应向这些患者提供重症监护。
方法：在本研究中，对377例SBP患者和794例腹水患者进行微生物谱分析，抗菌素耐药性概况，和实验室发现。
结果：最常见的病原体是大肠杆菌（96，25.5％），表皮葡萄球菌（55，14.6%），和屎肠球菌（42，11.1%）。多药耐药（MDR）细菌占49.7％的革兰氏阳性菌（GPB）和48.8％的革兰氏阴性菌（GNB）。最敏感的抗生素是阿米卡星（91.5%），美罗培南(89.8%)和哌拉西林/他唑巴坦(87.6%)。广泛耐药（XDR）（OR=51.457，p<0.001），中性粒细胞计数（OR=1.088，p<0.001），终末期肝病模型（MELD）评分（OR=1.124，p<0.001）是SBP患者住院死亡率的独立预测因素。
结论：MDR占SBP患者分离出的细菌的近一半，其中，产超广谱β-内酰胺酶和耐碳青霉烯类细菌的高患病率令人担忧。XDR的存在，较高的MELD分数，和中性粒细胞计数是SBP患者院内死亡率较高的独立预测因素,表明应向这些患者提供重症监护。
