腹膜透析相关性腹膜炎的致病菌及其耐药性分析  

Peritoneal Dialysis-Related Peritonitis:Pathogenic Bacteria and Its Drug Resistance Analysis

作　　者：张蓓茹[1] 吴岩[1] 张静娟[1] 李丹[1] 刘佳[2] 孙继梅[3] 李德天[1] 

机构地区：[1]中国医科大学附属盛京医院肾内科,辽宁省沈阳市110004 [2]葫芦岛市中心医院泌尿内科 [3]中国医科大学附属盛京医院检验科

出　　处：《中国全科医学》2012年第11期1254-1256,共3页Chinese General Practice

摘　　要：目的探讨腹膜透析相关性腹膜炎的致病菌及其药物敏感性。方法回顾性分析69例腹膜透析相关性腹膜炎的致病菌、药敏试验结果、疗效以及转归。结果 69例腹膜透析相关性腹膜炎腹透流出液培养,48例培养阳性,阳性率为69.60%,其中革兰阳性球菌19例(39.59%),革兰阴性杆菌18例(37.50%),真菌11例(22.91%)。药敏结果显示革兰阳性球菌对万古霉素均敏感,对青霉素的耐药率最高,达80.00%,对苯唑西林和左氧氟沙星也有较高的耐药率,分别为63.64%和52.63%。革兰阴性杆菌对氨苄西林的耐药率最高,达75.00%,对庆大霉素的耐药率较低,仅为18.75%,对亚胺培南均敏感。真菌中以近平滑念珠菌所占比例最高。革兰阳性球菌感染预后较好,真菌感染预后差。结论虽然革兰阳性球菌仍是腹膜透析相关性腹膜炎的主要致病菌,但是革兰阴性杆菌和真菌所致腹膜炎的比例明显增加。真菌感染临床预后差,要采取有效措施预防。Objective To explore the pathogenic bacteria causing peritoneal dialysis-related peritonitis and its drug sensitivity.Methods 69 cases suffering peritoneal dialysis-related peritonitis were analyzed retrospectively about the pathogenic bacteria,drug susceptibility test,curative effect and prognosis.Results Of the peritoneal fluid culture of the 69 patients,48 were found positive and the positive rate was 69.60%,among which 19 cases（39.59%） were infected with gram positive cocci,18 cases（37.50%） with gram negative cocci and 11 cases（22.91%） with fungi.Drug sensitivity test results showed that gram positive cocci was sensitive to vancomycin in all cases,but it has the highest resistance rate to penicillin（80.00%）.It was also resistant to oxacillin and levofloxacin（63.64% and 52.63% respectively）.Gram negative bacilli were sensitive to lmipenem in all cases,but they had the highest resistance rate of 75.00% to ampicillin and a low resistance rate of 18.75% to gentamicin.Candida parapsilosis had the highest proportion in fungal.The patients infected with gram positive cocci peritonitis usually had a good prognosis,but those with fungal peritonitis had a bad prognosis.Conclusion Gram positive cocci is still the main pathogen causing peritoneal dialysis-related peritonitis,but the proportion of peritonitis caused by gram negative bacilli and fungi increases dramatically.The fungi peritonitis has a bad prognosis,therefore effective prevention measurements are needed.

关 键 词：腹膜透析 腹膜炎 细菌 抗菌药 

分 类 号：R459.51[医药卫生—治疗学] R656.41[医药卫生—临床医学]