腹膜透析相关性腹膜炎经验用药分析  

Empiric initial therapy in peritoneal dialysis-related peritonitis

作　　者：晏焕青[1] 李芸[2] 保永军[1] 唐粼[2] 黄鑫[1] 周国秀[1] 朱彤莹[2] 

机构地区：[1]复旦大学附属华山医院宝山分院肾脏科,上海200431 [2]复旦大学附属华山医院肾内科

出　　处：《中华肾脏病杂志》2011年第12期899-902,共4页Chinese Journal of Nephrology

摘　　要：目的研究华山医院及宝山分院腹膜透析（腹透）相关性腹膜炎的致病菌、耐药性及患者转归，为临床经验用药提供依据。方法回顾性分析2007年1月至2010年1月上述两医院腹透中心收治的93例腹透相关性腹膜炎的临床表现、致病菌、耐药性及转归。结果75例腹透液培养阳性，阳性率为80．2％，其中革兰阳性球菌45例，革兰阴性杆菌21例，真菌2例，革兰阳性杆菌1例，革兰阴性球菌1例，多种菌混合感染5例。革兰阳性球菌主要以凝固酶阴性的葡萄球菌为主，所有革兰阳性球菌对万古霉素均敏感，但对头孢唑林耐药率高达60．0％，而且耐药率有明显的逐年增加趋势。革兰阴性菌对头孢他啶的耐药率达到46．1％，所有革兰阴性杆菌对亚胺培南均敏感。因腹膜炎而退出腹膜透析有16例，退出率为17．2％（16／93）。腹腔使用万古霉素对残肾功能无显著影响。结论两院腹透中心腹透相关腹膜炎致病菌以革兰阳性球菌为多数。头孢唑啉耐药性逐年增高，目前不再适合作为初始治疗的经验用药。腹腔使用万古霉素可推荐作为革兰阳性菌致腹膜炎的初始经验用药。Objective To investigate the pathogens, drug resistance and outcomes ol continuous ambulatory peritoneal dialysis （CAPD） patients with peritoneal dialysis related peritonitis in our peritoneal dialysis （PD） centers. Method Data including clinical manifestations, pathogens, treatment, outcome of 93 CAPD cases with peritoneal dialysis-related peritonitis in our peritoneal dialysis （PD） centers were retrospectively analyzed. Results Dialysate culture of 75 cases was positive with a positive rate of 80.2%, including 45 cases of gram-positive cocci,21 cases of gram-negative bacilli, 2 cases of fungi and 5 cases of mixed infection. Coagulase negative staphylococci were the most common gram-positive cocci. All the gram-positive cocci were sensitive to vancomycin, but the resistance rate to cefazolin was 60.0% with an increasing tendence year by year. Resistance rate of gram-negative bacilli to ceftazidime was 46.1%. All the gram negative bacilli were sensitive to imipenem. The withdraw rate of CAPD was 17.2% （16/93） because of peritonitis. No obvious side-effect of peritoneal administration of vancomycin was found. Conclusions Gram-positive cocci are major pathogens in CAPD-related peritonitis. Now cefazohn is not suitable for the empiric initial treatment. Peritoneal administration of vancomycin should be recommended for peritonitis caused by gram positive cocci.

关 键 词：腹膜透析 腹膜炎 抗药性 抗生素 

分 类 号：R446.5[医药卫生—诊断学]