Abstract: Objective To study the risk factors for third-generation cephalosporin resistant bacteria infection in patients with cirrhosis ascites and spontaneous bacterial peritonitis (SBP).Methods The clinical data of 158 cirrhotic ascites patients with SBP from November 2014 to November 2019 were analyzed retrospectively.According to the results of drug sensitivity,the patients were divided into resistance group (77 cases with third-generation cephalosporin resistant bacteria in ascites) and non-resistance group (81 cases without third-generation cephalosporin resistant bacteria in ascites).The composition of pathogenic bacteria in the 2 groups was investigated.And the independent influencing factors for third-generation cephalosporin resistant bacteria infection in patients with cirrhosis ascites and SBP were analyzed by multivariate logistic regression.Results The types of third-generation cephalosporins involved in drug susceptibility testing included ceftazidime,ceftriaxone,cefoperazone and cefotaxime.Pathogens in the resistance group were resistant to the above 4 drugs,while those in the non-resistance group were sensitive.The proportions of Escherichia coli and Enterococcus faecalis in the resistance group were significantly higher than those in the non-resistance group (P<0.05),while the proportions of Klebsiella pneumoniae,Streptococcus and Corynebacterium were significantly lower than those in the non-resistance group (P<0.05).The proportions of patients with broad-spectrum antibiotics exposure in recent 3 months and reemerging SBP in the resistance group were significantly higher than those in the non-resistance group (P<0.05).The blood creatinine level was significantly higher in the resistance group than that in the non-resistance group (P<0.05),and the blood bicarbonate level was significantly lower in the resistance group than that in the non-resistance group (P<0.05).Broad-spectrum antibiotic exposure in recent 3 months,SBP history and blood bicarbonate were independent influencing factors for the third-generation cephalosporin resistance bacteria infection in patients with cirrhotic ascites and SBP (P<0.05).Conclusion Broad-spectrum antibiotic exposure in recent 3 months,SBP history,and low-level blood bicarbonate are closely related to the infection of third-generation cephalosporin resistant bacteria in patients with cirrhosis ascites and SBP.Selection of third-generation cephalosporin in patients with these characteristics should be with more caution.

Key words: Liver cirrhosis, Ascites, Spontaneous bacterial peritonitis, Cephalosporin, Drug resistance, Risk factors