肠源性与非肠源性腹膜透析相关性腹膜炎的临床特点及预后  

The clinical characteristics and outcome in peritoneal dialysis related enterogenic and non-enterogenic peritonitis

作　　者：许戎[1,2] 胡宁 阿荣其其格[4] 李孜[5] 董捷[1,2] 

机构地区：[1]北京大学第一医院肾内科 [2]北京大学肾脏病研究所 卫生部重点实验室教育部慢性肾脏病防治重点实验室,北京1000341 [3]宁夏人民医院肾内科,银川750021 [4]内蒙古锡林郭勒盟医院内二科,锡林浩特市026000 [5]四川大学华西医院肾内科,成都610041

出　　处：《中国血液净化》2012年第11期621-625,共5页Chinese Journal of Blood Purification

摘　　要：目的调查肠源性与非肠源性腹膜透析相关腹膜炎的人群特点、细菌谱、耐药率及转归。方法对2008年1月至2011年8月北京大学第一医院腹膜透析中心258例次腹膜炎进行回顾分析。结果有241例次腹膜炎送检腹膜透析液培养,其中177例次阳性(培养阳性率73.4%),肠源性细菌52例次,最多见为大肠埃希菌(26例次)。非肠源性细菌118例次,最多见为表皮葡萄球菌(42例次)。肠源性细菌与非肠源性细菌耐药谱存在一定的差异,而两者对青霉素、氨苄西林、哌拉西林、头孢呋辛、红霉素的耐药率均高于50.0%,对于头孢哌酮/舒巴坦、万古霉素、亚胺培南、美洛培南均为100%敏感。肠源性细菌性腹膜炎退出率显著高于非肠源性细菌性腹膜炎(26.9%比11.0%,P=0.009)。结论肠源性与非肠源性细菌具有不同的耐药谱,腹膜炎预后也存在差异。Objective To investigate the antibiotic-resistance and prognosis of CAPD related enterogenic and non-enterogenic peritonitis.Methods We retrospectively analyzed the pathogens,antibiotic-resistance and outcome in 258 episodes of CAPD related peritonitis encountered in Peritoneal Dialysis Center of Peking University First Hospital in the period between January 2008 to August 2011.Results Of the 177 culture-positive episodes（positive rate = 73.4%）,52 episodes were infected by enterogenic bacteria（including 26 episodes by E.coli）,and 118 episodes were infected by non-enterogenic bacteria（including 42 episodes by Staphylococcus epidermidis）.The spectrum of antibiotic-resistance was different between enterogenic bacteria and non-enterogenic bacteria.However,both kinds of bacteria had more than 50% antibiotic-resistance rate to Penicillin,Ampicillin,Piperacillin,Cefuroxime and Erythromycin,but were 100% sensitive to Cefoperazone/sulbactam,Vancomycin,Imipenem,and Meropenem.Enterogenic peritonitis had a higher dropout rate than non-enterogenic peritonitis（26.9% vs.11%,P=0.009）.Conclusion Antibiotic-resistance and prognosis of peritonitis were different between CAPD related enterogenic and non-enterogenic peritonitis.

关 键 词：腹膜炎 肠源性细菌 耐药性 

分 类 号：R459.5[医药卫生—治疗学]