腹膜透析相关性腹膜炎患者的病原菌分析研究  

Pathogens causing peritoneal dialysis-related peritonitis

作　　者：万力[1,2] 杨林[1,2] 杨芦蓉[1,2] 刘晓姣[1,2] 夏敬彪[1,2] 

机构地区：[1]三峡大学第一临床医学院 [2]宜昌市中心人民医院肾病科,湖北宜昌443003

出　　处：《中华医院感染学杂志》2015年第5期1022-1024,共3页Chinese Journal of Nosocomiology

基　　金：百特中国肾科研究基金资助项目(CHN-RENAL-IIS-2011-045)

摘　　要：目的分析医院腹膜透析患者相关性腹膜炎的发病原因、病原菌及耐药性,为临床对腹膜透析相关性腹膜炎的防治提供依据。方法回顾性分析2011年4月-2013年8月住院的腹膜透析相关性腹膜炎46例患者病原菌种类、耐药性特点及转归。结果 46例患者腹膜透析液培养阳性32例,阳性率为69.57%;共分离鉴定出33株病原菌,其中革兰阳性菌20株占60.61%,以表皮葡萄球菌为主,革兰阴性菌10株占30.30%,以大肠埃希菌多见,真菌3株占9.09%;革兰阳性菌对青霉素耐药率最高,达到85.00%,对万古霉素、利奈唑胺、阿米卡星等耐药率为0,革兰阴性菌对头孢唑林耐药率最高,为66.67%,对亚胺培南、美罗培南、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦等耐药率均为0;真菌性腹膜炎的预后最差。结论医院腹膜透析相关性腹膜炎的病原菌以革兰阳性菌为主,但培养阳性率有待进一步提高;经验性治疗时可选用一代头孢菌素或万古霉素联合三代头孢菌素或氨基糖苷类的治疗方案,但应根据具体的药敏试验结果及时调整并合理的应用抗菌药物。OBJECTIVE To analyze the causes of peritoneal dialysis‐related peritonitis and observe the distribution and drug resistance of pathogens so as to provide guidance for clinical prevention and treatment of the peritoneal di‐alysis‐related peritonitis .METHODS A total of 46 patients with peritoneal dialysis‐related peritonitis who were hospitalized from Apr 2011 to Aug 2013 were enrolled in the study ,then the distribution and drug resistance of the pathogens as well as the clinical outcomes were retrospectively analyzed .RESULTS The peritoneal dialysates were cultured positive in 32 of 46 patients ,with the positive rate of 69 .57% .A total of 33 strains of pathogens have been isolated ,including 20 （60 .61% ） strains of gram‐positive bacteria ,10 （30 .30% ） strains of gram‐negative bacteria ,and 3 （9 .09% ） strains of fungi;the Staphylococcus epidermidis was the predominant species of gram‐positive bacteria ,and the Escherichia coli was dominant among the gram‐negative bacteria .The drug resistance rate of the gram‐positive bacteria to penicillin was the highest （85 .00% ） ,the drug resistance rates to vancomycin , linezolid ,and amikacin were 0;the drug resistance rate of the gram‐negative bacteria to cefazolin was the highest （66 .67% ） ,and the drug resistance rates to imipenem ,meropenem ,cefoperazone‐sulbactam ,and piperacillin‐tazobactam were 0 .The prognosis of the fungal peritonitis was the poorest .CONCLUSION The gram‐positive bac‐teria are the predominant pathogens causing the peritoneal dialysis‐related peritonitis ,but the positive rate of cul‐ture needs to be further raised .The first generation of cephalosporins or vancomycin combined with the third gen‐eration of cephalosporins or aminoglycosides can be used for empirical therapy ,and it is necessary to adjust the drug therapy and reasonably use antibiotics on the basis of the results of drug susceptibility testing .

关 键 词：腹膜透析 腹膜炎 病原菌 耐药性 

分 类 号：R378[医药卫生—病原生物学]