腹膜透析相关性腹膜炎细菌谱变迁及药敏分析  

Analysis of bacteria spectrum change and drug sensitivity for peritoneal dialysis-associated peritonitis

作　　者：黎金秋 韦晓芳 王成玉[1] Jinqiu Li;Xiaofang Wei;Chengyu Wang(Department of Nephrology,First Affiliated Hospital of Guangxi Medical University,Nanning 530021,Guangxi Zhuang Autonomous Region,China)

机构地区：[1]广西医科大学第一附属医院肾内科,南宁530021

出　　处：《中华肾病研究电子杂志》2022年第5期264-269,共6页Chinese Journal of Kidney Disease Investigation（Electronic Edition）

基　　金：广西自然科学基金项目(2018GXNSFAA050084)

摘　　要：目的探讨腹膜透析相关性腹膜炎患者感染细菌谱变迁及耐药情况,以指导合理使用抗生素。方法收集2012至2021年十年间我院发生的342例次腹透相关性腹膜炎患者的基本资料,比较前、后五年感染细菌谱及耐药性变化,分析不同细菌类型临床特点。结果本研究中腹透液培养共有159例次阳性,其中革兰氏阳性(G^(+))菌的占比最高,但比例随时间逐渐下降,而革兰氏阴性(G^(-))菌比例随时间逐渐上升,后五年较前五年高(P<0.05)。G^(-)菌中大肠埃希菌最为常见,后五年较前五年占比更高(P<0.05)。与G^(+)菌组相比,G^(-)菌组患者的透析龄更长,住院费用更多,合并插管出口感染更多,因感染拔管比例更高。G^(-)菌组患者的血中性粒细胞百分比、C反应蛋白(CRP)水平、降钙素原(PCT)水平、腹透液的多形核细胞百分比也更高(P<0.05)。后五年细菌耐药率增多,大肠埃希菌对头孢类抗生素耐药率升高。结论G^(+)菌仍是腹透相关性腹膜炎的主要致病菌,但在后五年占比较前五年下降,而G^(-)菌占比逐渐上升,其中大肠埃希菌最常见。细菌的耐药率后五年较前五年高。相比G^(+)菌组,G^(-)菌组患者的炎症指标水平更高。Objective To explore the change of bacteria spectrum and drug resistance in patients with peritoneal dialysis-associated peritonitis(PDAP)in order to guide the rational use of antibiotics.MethodsThe basic data of 342 cases of PDAP from our hospital in the ten years from 2012 to 2021 were collected.The first and last five years were compared in the bacteria spectrum of infection and drug resistance change,and the clinical characteristics of different bacterial types were analyzed.ResultsIn this study,159 cases of peritoneal dialysate culture were positive,of which the proportion of Gram-positive(G^(+))bacteria was the highest and gradually decreased with time,while the proportion of Gram-negative(G^(-))bacteria gradually increased with time,and was higher in the last five years than in the first five years(P<0.05).Compared with G^(+)bacteria group,the G^(-)bacteria group patients had longer dialysis age,higher hospitalization costs,more intubation-outlet infections,and higher rate of extubation due to infection.Compared with G^(+)bacteria group,the G^(-)bacteria group patients also showed higher percentage of blood neutrophils,higher level of C-reactive protein(CRP),higher level of procalcitonin(PCT),and higher percentage of polymorphonuclear cells in the peritoneal dialysate(P<0.05).In the last five years,the rate of bacterial drug resistance increased,and the drug resistance rate of Escherichia coli to cephalosporins increased.ConclusionG^(+)bacteria were still the main pathogen of PDAP,but the proportion of G^(+)bacteria in the last five years was lower than in the first five years,while the proportion of G^(-)bacteria gradually increased,among which Escherichia coli was the most common.The drug resistance rate of bacteria in the last five years was higher than that in the first five years.Compared with the G^(+)bacteria group,the G^(-)bacteria group patients showed higher levels of inflammatory indicators.

关 键 词：腹膜透析相关性腹膜炎 病原菌 抗生素 耐药性 

分 类 号：R73[医药卫生—肿瘤]