To investigate the distribution and drug resistance of pathogens in ascites of patients with hepatitis B virus (HBV)-related liver cirrhosis complicated with spontaneous bacterial peritonitis (SBP), and to provide references to clinical rational drug use.

Total of 762 HBV-related liver cirrhosis patients complicated with SBP in Public Health Clinical Center of Chengdu from January 2010 to December 2017 were enrolled after informed consent. The pathogens identification and drug susceptibility test of the ascites specimens were performed.

Among the 762 patients, 158 cases were positive for pathogen culture, with the positive rate of 20.73%, and 166 strains of pathogenic bacteria were isolated, among which 151 patients (95.57%) with single infection, except for 7 patients as composite infection. A total of 98 strains (59.94%) were Gram-positive bacteria, 59 strains (35.54%) were Gram-negative bacteria and 9 strains (5.42%) were fungi, while 22 strains (13.25%) of extended-spectrum β-Lactamases (ESBLs)-producing bacteria were isolated. The most commonly isolated Gram-positive bacteria were Staphylococcus haemolyticus, Staphylococcus epidermidis, Staphylococcus cohnii and Enterococcus faecalis, with a total of 59.18% (58/98) in Gram-positive bacteria, remained highly resistance to penicillin G, erythrocin, clindamycin, oxacillin and tetracycline, but no resistance to vancomycin or teicoplanin strains occurred. Escherichia coli and Klebsiella pneumonia were dominant among the Gram-negative bacteria, accounting for 72.88% (43/59), mostly resistant to ampicillin, but none to imipenem or meropenem.

HBV-related liver cirrhosis patients with SBP are infected mainly by Escherichia coli, Klebsiella pneumonia and Staphylococcus haemolyticus. Clinicians should use antibiotics reasonably based on the ascites pathogen identification and drug resistance.