腹膜透析相关性腹膜炎致病菌与耐药性及危险因素分析  

PD-related Peritonitis Pathogenic Bacteria: Analysis of Their Drug Resistance and Risk Factors

作　　者：邵秋霞[1] 胡沙沙[1] 张丽丽[1] 赵军[2] 

机构地区：[1]潍坊医学院研究生院,山东省潍坊市261000 [2]潍坊市人民医院住院二部肾内科

出　　处：《中国全科医学》2015年第11期1326-1329,共4页Chinese General Practice

摘　　要：目的分析持续性非卧床性腹膜透析相关性腹膜炎(CAPDrp)患者的致病菌种类及对常用抗菌药物的耐药性,并研究其发病的独立危险因素。方法选取2009-05-01至2014-05-01于潍坊市人民医院治疗的167例腹膜透析(CAPD)汉族患者为研究对象,分为非感染组(80例)和感染组(87例)。收集患者一般资料和实验室检查指标,无菌留取透析液分别行细菌、真菌培养,并行药敏试验。结果感染组发生109例次CAPDrp,79例次致病菌培养阳性,阳性率为72.5%。分离鉴定出93株致病菌,其中G+菌48株(51.6%),以表皮葡萄球菌(21.5%)为主;G-菌39株(41.9%),以大肠埃希菌(30.1%)为主;真菌6株(6.5%)。G+菌对青霉素耐药率最高(81.0%),对万古霉素均敏感。G-菌对阿米卡星及亚胺培南敏感性较高,对左氧氟沙星、头孢噻肟、庆大霉素、头孢曲松耐药性相对较高。真菌对氟康唑、5-氟胞嘧啶和两性霉素均敏感。两组年龄,高血压、冠心病、糖尿病检出率,总蛋白、清蛋白水平比较,差异有统计学意义(P<0.05)。冠心病〔β=1.166,Waldχ2=10.085,OR=3.210,95%CI(2.491,3.929),P=0.001〕、糖尿病〔β=1.502,Waldχ2=16.833,OR=4.489,95%CI(3.771,5.206),P<0.001〕为CAPDrp发病的独立危险因素。本研究中,CAPDrp感染率为55.07月/次。结论 CAPDrp致病菌以表皮葡萄球菌、大肠埃希菌为主,G+菌、G-菌分别对万古霉素及阿米卡星和亚胺培南较敏感,合并冠心病、糖尿病为CAPDrp发病的独立危险因素。Objective To analysis the pathogenic bacteria of continuous ambulatory peritoneal dialysis-related peritonitis（ CAPDrp） and their drug resistance and independent risk factors. Methods From May 1,2009 to May 1,2014,in Weifang People＇s Hospital,167 Han patients who had continuous ambulatory peritoneal dialysis（ CAPD） were divided into groups non-infected（ n = 80）, infected（ n = 87）. Patients＇ general data, laboratory parameters were collected, and bacterial,fungal cultures and drug sensitive test were carried out. Results CAPDrps occurred 109 case-times in infected group,79 case-time（ 72. 5%） pathogenic bacteria cultures were positive. A total of 93 strains of pathogenic bacteria were isolated and identified,including 48 strains（ 51. 6%） of G＋cocci, mainly Staphylococcus Epidermidis（ 21. 5%）, and 39strains（ 41. 9%） of G-bacilli,mainly Escherichia coli（ 30. 1%）,and 6 strains（ 6. 5%） of fungus. G＋cocci were sensitive to vancocin and their drug resistance to penicillin was the highest（ 81. 0%）. G-bacilli were well sensitive to amikacin and imipenem and their drug resistance higher to levofloxacin, cefotaxime, gentamicin, ceftriacone. Fungi were sensitive to fluconazole,5-fluorocytosine,amphoterincin. There was significant difference in age,hypertension,coronary heart disease（ CHD）,diabetes,total protein,albumin between 2 groups（ P〈0. 05）. CHD 〔β = 1. 166,Wald χ2= 10. 085, OR =3. 210,95% CI（ 2. 491,3. 929）,P = 0. 001〕and diabetes〔β = 1. 502,Wald χ2= 16. 833,OR = 4. 489,95% CI（ 3. 771,5. 206）,P〈0. 001〕were independent risk factors of CAPDrp. In this study, infection rate of CAPDrp was 55. 07 month /times. Conclusion CAPDrp pathogenic bacteria are mainly Staphylococcus Epidermidis,Escherichia coli,and G＋bacterial are sensitive to vancocin and G-bacterium sensitive to amikacin and imipenem. CHD,diabetes are independent risk factors of CAPDrp.

关 键 词：腹膜炎 腹膜透析 持续不卧床 致病菌 耐药性 危险因素 

分 类 号：R572.2[医药卫生—消化系统]