| Objective:Through studying the bacteriological and drug resistant characteristics of multidrug-resistant organisms(MDROs)infection in patients with cirrhosis and spontaneous bacterial peritonitis(SBP),and analyzing the predictive factors of MDROs infection in patients with cirrhosis and SBP,the study was aimed to strengthen the understanding of this disease,and provide experiential treatment suggestions before the results of antibiotic sensitivity test for ascites culture and conduct the selection of antibacterial agents in clinical practice,and improve the prognosis of the SBP patients.Methods:We retrospectively analyzed the clinical data of 139 patients with spontaneous bacterial peritonitis in cirrhosis,whose ascites culture was positive,hospitalized in the Department of Hepatology of the First Hospital of Jilin University from November 1,2012 to November 1,2018.We can get the characteristics of bacteriology and drug resistance from ascites culture results.We collected the basic clinical data,serum tests and ascites tests,and divided these patients into two groups by multidrug-resistant organisms infection or not.Univariate analysis and multivariate logistic regression analysis were performed on the collected data to screen out the predictors of MDROs infection in patients with cirrhosis and SBP,and the predictive value of the indicator was evaluated by the receiver operating characteristic curve(ROC curve).The Youden index was applied to determine the cutoff value for the diagnosis of MDROs infection.Results:In this study,139 episodes with cirrhosis and spontaneous bacterial peritonitis were positive for ascites culture,and 169 strains of bacteria were isolated.15 episodes were infected by two or more kinds of bacteria.Of the 139 episodes,48 episodes were G~-bacteria infection(34.5%),2 episodes were compound infection of G~-bacteria(1.4%),68 episodes were G~+bacteria infection(48.9%),10 episodes were compound infection of G~+bacteria(7.2%),and 11 episodes were infected with G~-bacteria and G~+bacteria simultaneously(7.9%).Of the 169 strains of bacteria,65 were G~-bacteria(38.5%)and 104 were G~+bacteria(61.5%).G~+bacteria are the main pathogens.The proportion of Staphylococcus,Enterobacteria,Streptococcus,Enterococcus,Acinetobacter,other bacteria and Pseudomonas aeruginosa was 28.4%(48/169),26.6%(45/169),21.9%(37/169),11.2%(19/169),4.7%(8/169),2.4%(4/169),respectively.Among the G~-pathogens,Escherichia coli accounted for 44.6%(29/65),the other Enterobacteria accounted for 24.6%(16/65),Acinetobacter and Pseudomonas aeruginosa accounted for 12.3%(8/65)and 6.2%(4/65),respectively.Among the G~+pathogens,the proportion of Streptococcus,coagulase negative Staphylococcus(CNS),Enterococcus,methicillin-resistant coagulase negative Staphylococcus(MRCNS)and Staphylococcus aureus was 35.6%(37/104)?25.0%(26/104)?18.3%(19/104)?17.3%(18/104)?3.8%(4/104),respectively.Staphylococcus,which include the CNS,MRCNS and Staphylococcus aureus,accounted for the highest proportion at 46.1%.Escherichia coli was the dominant bacteria in G~-bacteria.Its drug resistance rate to cefotaxime,ceftriaxone and cefepime was 65.0%(13/20),65.5%(19/29)and 20.7%(6/29),respectively.The drug resistance rate to imipenem,meropenem and moxifloxacin was all zero.The drug resistance rate to levofloxacin was 58.6%(17/29).Staphylococcus was the main pathogen in G~+bacteria.It had no drug resistance to teicoplanin,linezolid,vancomycin and tegacycline.The drug resistance rate of Enterococcus to teicoplanin and vancomycin was 16.7%(2/12)and 31.6%(6/19),respectively.The drug resistance rate to linezolid and tegacycline was zero.The drug resistance rate of CNS,MRCNS and Enterococcus to moxifloxacin was 37.5%(6/16),37.5%(6/16)and57.1%(4/7),respectively.The patients with multidrug-resistant organisms infection accounted for44.6%(62/139)of the 139 episodes.Among the 169 strains of isolated bacteria,41.4%(70/169)were multidrug-resistant organisms.Escherichia coli,MRCNS,Enterococcus and CNS were the main multidrug-resistant organisms,accounting for34.3%(24/70),22.9%(16/70),17.1%(12/70)and 17.1%(12/70),respectively.The results of univariate analysis showed that there were significant differences in gender,age,international normalized ratio and prothrombin time between MDROs infection group and non-MDROs infection group(P<0.05).Multivariate logistic regression analysis revealed that prothrombin time was a predictive factor of MDROs infection in patients with cirrhosis and SBP(OR 1.064;95%CI:1.009-1.122;P=0.023).The area under receiver operating characteristic curve was 0.621.The cutoff value was 17.3 seconds through Youden index.Conclusions:1.Staphylococcus,Enterobacteria,Streptococcus and Enterococcus are the common pathogens in patients with cirrhosis and SBP,and the gram stain positive bacteria are the main pathogens.2.The drug resistance rate of pathogenic bacteria to the third generation of cephalosporins and the quinolones is high,but its drug resistance rate to imipenem,meropenem,teicoplanin,vancomycin,linezolid and tegacycline is low.3.Nearly half of the pathogens of patients with cirrhosis and SBP are multidrug-resistant organisms.The common multidrug-resistant organisms are Escherichia coli,MRCNS,Enterococcus and CNS.4.Prothrombin time is a important predictive factor of MDROs infection in patients with cirrhosis and SBP. |
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