万古霉素联合美罗培南作为腹膜透析相关性腹膜炎经验用药的疗效分析  

Analysis of curative effect of Vancomycin combined with Meropenem as empirical treatment of peritoneal dialysis-related peritonitis

作　　者：王婵媛[1] 吴永贵[1] 齐向明[1] 王娟[1] 赵珉[1] 戴宏[1] 卢文[1] 

机构地区：[1]安徽医科大学第一附属医院肾内科

出　　处：《临床肾脏病杂志》2015年第2期86-89,共4页Journal Of Clinical Nephrology

摘　　要：目的通过万古霉素联合美罗培南作为腹膜透析相关性腹膜炎（peritoneal dialysis-related peritonitis，PDRP）经验用药的疗效分析，为临床经验性用药提供一定的依据。方法回顾性分析2011年6月至2014年6月在安徽医科大学第一附属医院住院的106例PDRP病例，按治疗方案分为治疗组44例和对照组62例。治疗组给予万古霉素＋美罗培南治疗，对照组给予万古霉素＋其他（三代头孢或氨基糖苷类）治疗。抽取PDRP患者首袋浑浊的腹膜透析液，送检细胞计数分类，并进行培养及药敏试验。收集患者临床资料，包括出现症状至入院时间，腹膜透析液白细胞计数、血红蛋白、白蛋白、血白细胞、中性比、C反应蛋白等指标，腹膜透析液培养及药敏结果等情况。结果106例患者中以革兰阳性球菌为主，革兰阳性菌中耐药率最低的是利奈唑胺，万古霉素，莫西沙星；革兰阴性菌中耐药率最低的是美罗培南、妥布霉素、哌拉西林他唑巴坦。万古霉素联合美罗培南治疗后腹膜透析液白细胞计数显著下降，与对照组相比有统计学意义（P〈0．05），且退出率、病死率、霉菌检出率低于对照组，预后较好。结论腹腔经验性应用万古霉素联合碳青霉烯类能迅速控制腹膜透析液白细胞计数，预后较好，且符合我中心的药敏结果，推荐作为部分腹膜透析相关性腹膜炎初始经验用药，以供临床医生参考。Objective To analyze the curative effect of Vancomycin combined with Meropenem as empirical treatment of peritoneal dialysis-related peritonitis, and provide the basis for clinical empiric therapy. Methods A total of 106 cases of PD-related peritonitis from the First Affiliated Hospital of Anhui Medical University between June 2011 and June 2014 were reviewed, and divided into two groups according to the initial empirical treatments： Vancomycin combined Meropenem as the treatment group, and Vancomycin combined others （the third-generation cephalosporins or aminoglycosides） as the control group. The white blood cells were counted and drug sensitivity test was done. Clinical data, pathogens, resistance and outcomes of the 106 cases of peritoneal dialysis-related peritonitis were analyzed retrospectively. Results Most of pathogens were gram-positive aureus. Drug sen- sitivity test of the gram-positive strains showed that the three antibiotics with lowest antibiotic resistance were Linezolid, Vancomyein and Moxifloxacin. Drug sensitivity test of the gram-negative bacteria showed that antibiotics with the lowest resistance were Meropenem, Tobramycin and Piperaeillin tazobactam. The number of white blood cells in the peritoneal dialysate was significantly decreased in the patients treatedwith Vaneomycin and Meropenem （P〈0. 05）, and exit rate, mortality and mold detection rate were lower. Conclusions Vancomycin and Meropenem can rapidly reduce the number of white blood cells in the peritoneal dialysate, and are recommended as the initial empirical treatment in a part of peritoneal dialysis-related peritonitis.

关 键 词：持续性非卧床腹膜透析 腹膜炎 经验用药 细菌耐药性 

分 类 号：R692.5[医药卫生—泌尿科学]