中文摘要：

目的了解继发性腹膜炎患者需氧病原菌的变迁及致病菌谱和耐药谱变化的影响因素,指导临床合理使用抗菌药物。方法对近8年来收治于安徽医科大学第一附属医院外科且腹水培养阳性的继发性腹膜炎患者进行回顾性研究。结果 104例患者的腹水中共分离出119株需氧致病菌,革兰阴性菌仍是该病的主要致病菌（66.4%）,但有明显下降趋势（P=0.001）;肠球菌属已替代葡萄球菌属成为继发性腹膜炎最主要的革兰阳性菌;真菌的分离率增高明显（P=0.001）。住院时间（≥5d）和经验用药都能导致革兰阳性菌的构成比增高（P=0.003,P=0.009）,且前者与革兰阴性菌耐药谱的变化和多重耐药株的产生具有相关性。结论选用抗菌药物治疗时,应考虑到住院时间和经验用药对细菌谱和耐药谱的深远影响,早期及时的细菌学培养对继发性腹膜炎的治疗具有重大意义。

英文摘要：

Objective To investigate the current changes in bacterial distribution and the factors that cause the changes in aerobic pathogens distribution and drug resistance in order to guide the rational use of antibiotics.Methods This retrospective study,conducted at the surgical department of the first affiliated hospital of Anhui Medical University in recent eight years,included all patients diagnosed with secondary peritonitis whose ascitic fluid bacterial culture was positive.Results 119 aerobic strains were isolated from 104 different ascitic fluid specimens.The main causative organisms was Gram-negative bacteria （66.4% ） ,but shown a significant declined trend （P = 0.001） in recent years.The majority of Gram-positive bacteria were Enterococcus instead of Staphylococcus.The isolated rate of fungus were rising（P = 0.001） .The proportion of Gram-positive bacteria were increased with the extension of the length of hospital stay（≥5 days） and the use of empirical antimicrobial therapy（P = 0.003;P = 0.009） .The former were significantly associated with the resistance spectrum of Gram-negative bacteria and the presence of multidrug-resistant bacteria.Conclusion The influence of the length of hospital stay and empirical treatment in bacterial spectrum and resistance spectrum should be taken into account in antibiotic therapy.Early bacterial cultivation is advantageous for the clinical diagnosis and the treatment of secondary peritonitis.