持续性非卧床腹膜透析腹膜炎的致病菌及其耐药性  

Pathogens and their resistance in CAPD-related peritonitis

作　　者：杨念生[1] 钟琼 陈雄辉[1] 汪涛[1] 叶任高[1] 余学清[1] 

机构地区：[1]中山医科大学附属第一医院肾内科卫生部肾脏病临床研究重点实验室,广州510080 [2]广东省顺德市勒流医院内科

出　　处：《中华肾脏病杂志》2001年第6期375-378,共4页Chinese Journal of Nephrology

基　　金：广东省科学委员会自然科学基金(990075);广东省科学委员会攻关基金(99B06705G)

摘　　要：目的 探讨持续性非卧床腹膜透析（ＣＡＰＤ）腹膜炎的致病菌及其耐药性。方法 回顾性分析１０９例ＣＡＰＤ腹膜炎的临床表现、致病菌、耐药性和转归情况。结果４３例培养阳性，透出液培养阳性率为 ３９．４％，其中１１例为革兰阳性球菌，１９例为革兰阴性杆菌，１３例为真菌。主要的革兰阴性杆菌包括肺炎克雷白氏杆菌、大肠杆菌、不动杆菌和铜绿假单胞菌。革兰阴性杆菌对氨苄西林的耐药率最高，达８５．７％；对阿米卡星的耐药率最低，为１７．６％；庆大霉素的耐药享为４４．４％：而头孢他啶的耐药率也高达４２．９％。所有革兰阳性球菌对万古霉素敏感，大部分 （７１．４％）对头孢唑林敏感。腹腔内用抗真菌药对真菌性腹膜炎疗效不佳。腹膜炎ＣＡＰＤ的退出率为２０．２％（２２／１０９）。结论 革兰阴性杆菌腹膜炎比例有所增加，致病菌对庆大霉素和头抱他啶的耐药性较高，而对阿米卡星较敏感，宜作为经验用药。Objective To investigate the pathogens and their resistance in CAPD-related peritonitis. Methods Clinical manifestation, pathogens, resistance and outcomes of 109 cases of CAPD-related peritonitis were analyzed retrospectively. Results 43 cases were culture positive with a positive rate of 39. 4% . including 11 cases of gram-positive cocci, 19 cases of gram-negative bacilli and 13 cases of fungi. Klebsiella Pneumoniae, Escherichia Coli, Anectobacter and Pseudomonas aeruginosa were the most common causes of gram-negative bacilli, which showed high resistant rate of 85. 7% to ampicillin and low resistant rate of 17. 6% to amikacin. 44. 4% of bacilli were resistant to gentamycin and 42. 9% were resistant to ceftazidine. 71.4% of the gram-positive cocci were sensitive to cefazolin and all were sensitive to vancomycin. Intraperitoneal administration of anti-fungi agents was ineffective for fungal peritonitis. The total CAPD withdrawal rate in peritonitis was 20. 2% (22/109). Conclusions There is increasing proportion of peritonitis caused by gram-negative bacilli, which show increased resistance to gentamycin or ceftazidine and are generally sensitive to amikacin. Therefore, amikacin is recommended for empiric therapy for CAPD-related peritonitis.

关 键 词：腹膜透析 腹膜炎 抗生素 致病菌 耐药性 并发症 

分 类 号：R459.5[医药卫生—治疗学] R572.203[医药卫生—临床医学]