| ObjectiveTo evaluate the efficacy of short-term antibiotic treatment in patients with Cirrhosis complicated with spontaneous bacterial peritonitis(SBP). We aim to understand the pathogens spectrum of SBP and the bacterial resistance to antimicrobial agents. And then we try to evaluate the comprehensive intervention effect of antimicrobial agents in patients with SBP.Methods1. The cases of SBP with cirrhosis were collected retrospectively between 2006.1 and 2014.12 in a teaching infectious hospital. And then the fundamental data, laboratory date, clinic treatment and outcome were collected.2. Cases above-mentioned that conformed to ascites polymorphonuclear leukocytes(PMN) counts ≥ 250/mm3 and initial antibiotics with reasonable dosage and frequency in accordance with the requirements of the pharmacokinetic were included. And then the curative effect of short-term(5~7 days) and long-term(10~14 days) treatment course were analyzed retrospectively in spontaneous bacterial peritonitis.3. Investigate the ascites and/or blood culture results in above patients with SBP and to understand the changes of the spectrum of pathogenic bacteria and their resistant rates to antimicrobial agents over time.4. The group of rational use of antimicrobial drugs had intervened the diagnosis, selection and application of antibiotics of SBP patients above-mentioned.5. In order to understand the change trend of intervention, we divided the years into three periods, 2006~2008, 2009~2011 and 2012~2014.Results1. There were 1110 cases diagnosed with Cirrhosis complicated with SBP between 2006 and 2014.2. There were 250 cases included in the analysis of the course of antimicrobial drugs, among which 104 cases(41.6%) were short-term and 146 cases(58.4%), were long-term. The cure rate of short-term and long-term with β-lactamase enzyme inhibitor was 85.7%(36/42) and 82.5%(33/40) respectively, P=0.768, and the 30-day mortality was 7.1%(3/42) and 10%(4/40) respectively, P=0.709. On the whole, the cure rate of short-term and long-term was 76%(79/104) and 84.2%(123/146), P=0.101, and the 30-day mortality was 10.6%(11/104) and 7.5%(11/146) respectively, P=0.403.3. Ascites bacterial culture was performed in 917 cases during the study period. There were 217 strains of bacteria isolated from ascites and/or blood in 208 cases, among which 144 strains were from 140 cases whose ascites polymorphonuclear neutrophils counts were more than 250 cells/mm3, and the positive culture rates were 31.9%(140/493), 56 strains were from 54 cases whose ascites PMN<250/mm3(bacteria ascites) and 17 strains were from 14 cases with Primary hepatocellular carcinoma(HCC).3.1 Gram negative bacteria were the dominant bacteria(71.0%)and E. Coli were the most commonly isolated bacteria(59.7%). The proportion of Staphylococcus aureus declined from 6.8% in the first three years to 0% in the last three years, P=0.040.3.2 The resistant rates of E.coli to levofloxacin, three generations of cephalosporin, piperacillin/tazobactam and imipenem were 48.2%, more than 40%, 17.3% and 2.3% respectively. All of Pneumonia klebsiella were sensitive to levofloxacin, while 11.1% to16.7% of them was resistant to three generations of cephalosporin. All of excrement enterococcus was sensitive to vancomycin. Methicillin-resistant s. aureus bacteria were 40%(2/5).3.3 The resistant rate of E.coli to β-lactam enzyme inhibitor antimicrobial drugs declined from 50% in 2006 to 7.7% in 2013 during the period of investigation, P=0.003.4. There were 690 cases included in the analysis of comprehensive intervention of the reasonable application of antimicrobial.4.1 The proportion of cases diagnosed with ascites PMN≥250/mm3 was 41.4%(144 cases), 61.7%(111 cases) and 80.9%(131 cases) respectively in three periods, presenting a rising trend, P=0.000.4.2 The treatment of SBP with single antimicrobial drugs preferred by the fluoroquinolone or three generations of cephalosporin gradually into β- lactam enzyme inhibitors. The application of β-lactam enzyme inhibitors was 11cases(3.2%), 23cases(12.8%) and 110 cases(67.9%) during the three periods, P=0.000.4.3 The rational dose and frequency of antimicrobial drugs utilization improved significantly, with 71.3%(248 cases), 63.3%(114 cases) and 79.6%(129 cases) respectively during the three periods, P=0.004. At the same time, the application of antimicrobial treatment with short course(5 ~ 7 days) increased over times, with 16.3%(37 cases), 26.4%(29 cases) and 41.6%(47 cases) respectively, P=0.000.4.4 Nosocomial infection increased during the three periods, with 79 cases(22.7%), 27 cases(15.0%) and 45 cases(27.8%) respectively, P=0.015, while the cases of upper gastrointestinal hemorrhage reduced gradually, and the proportion were 5.7%(20 cases), 5.0%(9 cases) and 3.7%(6 cases) respectively during the three periods, P=0.618.4.5 The 30-day mortality rate was 8.3%, 7.8% and 8.6% respectively during the three periods, P=0.957. The overall 30-day mortality rate was 8.3%(57/690). And the risk factors related to death were complicated by shock(OR,3.193,95%CI,1.305~7.811,P=0.011),sepsis(OR,5.474,95%CI,1.758~17.043,P=0.003), gastrointestinal bleeding(OR,5.744,95%CI,2.865~11.514,P=0.000), hepatorenal syndrome(OR,2.321,95%CI,1.074~5.019,P=0.032)and hepatic encephalopathy(OR,2.619,95%CI,1.354~5.069,P=0.004) on the course by multiple factors regression analysis..Conclusions1. Short course of antimicrobial drug treatment was safe and effective in cirrhosis with SBP.2. Gram-negative bacteria were the main pathogenic bacterium causing SBP, and Escherichia coli was the most commonly isolated bacteria. There was no obvious change in the pathogenic bacteria spectrum, while the resistant rate of E.coli to β-lactam enzyme inhibitor had decreased.3. According to the comprehensive intervention of the reasonable application of antimicrobial drugs, the diagnostic criteria coincidence rate of SBP, the compliance rate of antimicrobial drugs, drug dose and frequency of rationalization rate and the short-term course of treatment rate were significantly improved, and the curative effect and 30-day mortality did not show obvious difference. |
PDF Full Text Request