摘要：目的 研究肝硬化合并自发性细菌性腹膜炎(spontaneous bacterial peritonitis, SBP)腹水细菌培养阳性患者的病原菌分布及药物敏感性，为SBP患者合理使用抗生素提供理论依据。方法 回顾性分析2011～2014年在首都医科大学附属北京地坛医院住院肝硬化伴有腹水症状且送检腹水细菌培养患者资料，研究对象为其中腹水细菌培养阳性患者。结果 肝硬化并有腹水症状且送检腹水细菌培养患者共638例，其中细菌培养阳性者67例(10.50％)。细菌培养阳性患者中共培养39株菌，其中革兰阴性杆菌19株(49％)，革兰阳性球菌20株(51％)。阳性率前5位的细菌依次是肠球菌7株(17.9％)、链球菌7株(17.9％) 、葡萄球菌6株(15.4％)、大肠埃希菌6株(15.4％)、铜绿假单胞菌3株(7.7％)，其它菌种均为革兰阴性杆菌，所占比例较小（共占25.7％）。革兰阴性杆菌对碳青霉烯类、氨基糖苷类等的敏感率较高，均超过83％；革兰阳性球菌对万古霉素敏感率为100 %。结论 肝硬化并发SBP患者细菌感染以革兰阳性球菌为主，其中革兰阳性球菌以屎肠球菌为主，革兰阴性杆菌以大肠埃希菌为主。临床治疗肝硬化并发SBP应在经验用药的基础上根据药敏结果合理应用抗生素。

Abstract Objective To investigate the clinical distribution and drug sensitivity of Pathogens isolated from Patients with liver cirrhosis complicated with spontaneous bacteria peritonitis. Methods Clinical distribution and drug sensitivity of bacterial strains isolated from ascites samples of patients with liver cirrhosis complicated with ascites symptoms were retrospectively analyzed. Results The positive strains in 638 samples of patients with liver cirrhosis complicated with spontaneous bacteria peritonitis were 67 (10.50％). Total 39 bacteria strains were cultured from these positive strains and there were 19 gram negative bacilli and 20 gram positive cocci. The isolation rates of mainly clinical strains ranged from high to low were 17.9% for enterococcus, 17.9% for streptococcus, 15.4% for Staphylococcus aureus, 15.4% for Escherichiacoli, 7.7% for Pseudomonas aeruginosa, and 25.7% for others. The cultured Gram-negative bacilli were most sensitive to Carbon penicilliumene and aminoglycoside with 83%, and the cultured Gram-positive bacteria were sensitive to vancomycin about 100%. Conclusion Escherichiacoli in gram negative bacilli and Ecfaecium in Gram positive cocci might be the main Pathogens causing liver cirrhosis complicated with SBP. It’s necessary to timely detect the pathogens for better clinical treatments to patients with liver cirrhosis complicated with ascites symptoms.