单中心腹膜透析相关性腹膜炎致病菌谱及经验性用药选择的临床研究  

Causative organisms and empirical treatment protocols in peritoneal dialysis-related peritonitis:a single center experience

作　　者：史艳玲[1] 邵蓉蓉[1] 林哲[1] 林海芳[1] 许菲菲[1] 黄朝兴[1] 林凡[1] 涂文婷[1] 

机构地区：[1]温州医学院附属第一医院肾内科,325000

出　　处：《浙江医学》2013年第14期1326-1329,共4页Zhejiang Medical Journal

摘　　要：目的探讨单中心腹膜透析(PD)相关性腹膜炎患者的致病菌谱、耐药状况及合理的经验性用药情况。方法选取PD相关性腹膜炎患者74例(共发生109例次PD相关性腹膜炎),记录其透析流出液培养结果、初始治疗方案、疗效和转归。结果共分离出103株病原菌,G^+菌69株(67.0%),G^-菌27株(26.2%),真菌7株(6.8%),培养阴性21例次(18.1%)。G^+菌中以凝固酶阴性葡萄球菌为主(30株、29.1%);G^-菌中以大肠埃希菌为主(13株,12.6%)。金黄色葡萄球菌对头孢唑啉耐药率为100.0%,未发现耐万古霉素的G^+菌;大肠埃希菌对头孢他啶的耐药率为20.0%。初始治疗方案含头孢唑啉和含万古霉素的疗效以及含左氧氟沙星/丁胺卡那霉素和头孢他啶的疗效均无明显差异(均P>0.05)。结论腹膜炎的致病菌谱仍以G^+菌为主。金黄色葡萄球菌对头孢唑啉耐药率达100%,不宜将头孢唑啉作为所有患者的经验性用药,头孢他啶、左旋氧氟沙星或丁胺卡那霉素均可作为初始用药。Objective To investigate the pathogens and their antibiotic resistance in patients with peritoneal dialysis （PD） -related peritonitis. Methods One hundred and nine episodes of PD-related peritonitis from 74 PD patients were treated at De- partment of Nephrology, the First Affiliated Hospital of Wenzhou Medical College from January 2008 to December 2010. Causative organisms, antibiotic sensitivity and effectiveness of the empirical treatment protocol were retrospectively analyzed. Results Total 103 strain pathogens were isolated： Gram-positive organisms caused 69 episodes peritonitis （67.0%）, gram-neg- ative organisms caused 27 episodes（26.2%）, fungi caused 7 episodes peritonitis （6.8%）, 21 cases were culture-negative. Coag- ulase- negative staphylococcus （30, 29.1% ）, especially Staphylococcus epidermidis （17, 16.5%） was the most common gram-positive pathogen. Escherichia coil was the most common gram-negative pathogen（13, 12.6%）. Resistant rate of S. aureus to cefazolin was 100.0%. Resistant rate of Escherichia coil to ceftazidime was 20.0%. There was no significant difference in cure rate between empirical treatment protocol including cefazolin group and that including vancomycin group （P 〉0.05）. There was also no significant difference in cure rate between empirical treatment protocol including ceftazidime group and that including levoflocaxin/amikacin group（P 〉0.05）. Conclusion Gram-positive bacteria, especially S. epidermidis are the main causative or- ganisms of PD-related peritonitis in our center. Cefazolin is unsuitable as an empirical antibiotic for all patients. Gram-negative organisms can be treated by ceftazidime, levoflocaxin or amikacin.

关 键 词：致病菌谱 耐药性分析 初始治疗 头孢唑啉 万古霉素 

分 类 号：R459.5[医药卫生—治疗学]