腹膜透析相关性腹膜炎的细菌谱及耐药性  

The bacteria spectrum and drug resistance analysis of peritoneal dialysis related peritonitis

作　　者：李倩[1] 袁自静[1] 朱江[1] 

机构地区：[1]南京医科大学附属江宁医院肾内科,211100

出　　处：《国际移植与血液净化杂志》2015年第4期5-8,共4页International Journal of Transplantation and Hemopurification

摘　　要：目的探讨腹膜透析相关性腹膜炎的病原学分析。方法回顾性分析南京医科大学附属江宁医院肾内科腹膜透析中心2008年1月1日至2015年5月20日期间收治的维持性腹膜透析患者中发生腹透相关性腹膜炎的患者共136例次，培养出致病菌96例，阳性率为70．59％；其中有2例患者为混合感染，培养出2种致病菌。致病菌中革兰氏阳性菌78株，占81．25％；革兰氏阴性菌15株，占15．63％；真菌3株，占3．13％。结果最常见的病原菌为表皮葡萄球菌（27／78）、头状葡萄球菌（15／78）；革兰氏阳性菌耐药率最低的为万古霉素、利奈唑胺，其耐药率均为0；革兰氏阴性菌对美罗培南、亚胺培南、阿米卡星、奈替米星、头孢哌酮舒巴坦耐药率最低，耐药率均为0；3例为真菌感染（3／96）。治愈率为91．91％。根据年份分组，多重耐药率呈逐年升高趋势。引起腹膜炎的最主要的原因为换液操作不规范以及肠道感染。结论多重耐药率逐年升高；革兰氏阳性菌仍是腹透相关性腹膜炎的主要致病菌；腹膜炎的治疗应根据细菌培养、药敏结果选择敏感有效的抗生素，腹膜炎经验治疗可选第一代头孢菌素（或万古霉素）加第三代头孢菌素（或氨基糖甙类药物）。真菌性腹膜炎治疗效果较差，应尽早拔管。Objective To investigate the etiological analysis of peritoneal dialysis related peritonitis. Methods To review 96 cases of drug-resistant bacteria, the positive rate was 70.59%, analysis of a total of 136 undergoing peritoneal dialysis patients during January 1, 2008 to May 20, 2015 in peritoneal dialysis center of Jiangning Hospital Affiliated to Nanjing Medical University. Two cases of them were mixed infection, cultivated 2 pathogenic bacteria. The gram positive bacteria were 78, accounting for 81.25%. The gram negative bacteria were 15, accounting for 15.63 % ; 3 cases were fungus, accounted for 3.13 %. Results The most common pathogens were coagulase negative staphylococci and Staphylococcus aureus. The lowest resistant rate of gram positive bacteria were vancomycin, linezolid. The lowest resistant rate of gram negative bacteria were meropenem, imipenem, Amikacin, netilmicin, Cefperazone-Sulbactam. 3 cases were fungal infection. The cure rate of all the patients was 91.91%. According to the year group, multiple resistant rate rise year by year （P 〈 0.05）. The main cause of peritonitis were non-standard operation of changing fluid and intestinal infection. Conclusion Multiple resistant rate increased year by year. Pathogenic gram positive bacteria remains the main bacteria of peritoneal dialysis related peritonitis. The treatment of peritonitis should be based on bacterial culture and drug sensitivity, then choose sensitive antibiotics. The experience treatment of peritonitis could choose first-generation cephalosporins or vancomycin and third-generation cephalosporins or amino-glycoside. The treatment of fungal peritonitis is poor, should be early extubation.

关 键 词：腹膜透析 腹膜透析腹膜炎 细菌谱 耐药性 

分 类 号：R656.41[医药卫生—外科学]