隧道口应用莫匹罗星乳膏结合口腔清洁对腹膜透析患者腹膜炎感染的影响  

Influence of portal use of mupirocin cream combined with oral cavity cleaning on peritonitis in peritoneal dialysis patients

作　　者：苏慧銮 吴智丹[1] 徐文坛 邓伦飞[1] 

机构地区：[1]海南省人民医院肾病风湿科,海南海口570311

出　　处：《中华医院感染学杂志》2017年第13期3055-3058,共4页Chinese Journal of Nosocomiology

摘　　要：目的探讨隧道口应用莫匹罗星乳膏结合口腔清洁对腹膜透析患者腹膜透析相关性腹膜炎感染的影响。方法选取医院2012年1月-2015年12月收治的腹膜透析患者160例为研究对象;采用随机数字表法将160例患者随机分为观察组和对照组,每组80例;对照组采用常规对症治疗和预防性措施,观察组患者在对照组基础上,每天隧道口换药后在腹透管出口处外涂莫匹罗星乳膏,同时要求患者每天刷牙3次,换药操作时戴口罩;门诊随访1年,记录两组隧道口炎、腹膜炎感染的发生率和腹膜炎感染住院治疗时间;感染隧道炎留取脓性分泌物培养+药敏试验,感染腹膜炎后留取留腹4小时以上透析后透出液行常规检查和腹透液培养,并做药敏试验。结果观察组隧道口炎、腹膜透析相关性腹膜炎感染发生率和腹膜透析相关性腹膜炎感染住院时间均显著低于对照组(P<0.05);在36例腹膜炎感染患者中,透出液培养阳性者32例,阳性率为88.89%;共培养出病原菌35株,其中3例患者培养出两种致病菌;35株病原菌中革兰阳性菌19株,占54.29%,革兰阴性菌16株,占45.71%;革兰阳性菌对莫匹罗星、万古霉素、利奈唑胺和替考拉宁耐药率较低,分别为0、5.26%、5.26%和0;革兰阴性菌对莫匹罗星、阿米卡星和头孢哌酮/舒巴坦的耐药率较低,分别为6.25%、6.25%和6.25%。结论隧道口使用莫匹罗星乳膏联合定期口腔清洁,有助于降低腹膜透析患者相关腹膜炎感染的发生,莫匹罗星乳膏可作为腹膜炎感染预防的首选药物。OBJECTIVE To explore the influence of portal use of mupirocin cream combined with oral cavity cleaning on peritoneal dialysis-related peritonitis in peritoneal dialysis patients.METHODS A total of 160 patients who received peritoneal dialysis in the hospital from Jan 2012 to Dec 2015 were recruited as the study objects and randomly divided into the observation group and the control group,with 80 cases in each group.The control group was treated with conventional symptomatic therapy and preventive measures,while the observation group was given additional mupirocin cream at outlet of dialysis tube each day after portal drug dressing based on the treatment of the control group,and the patients were required to brush teeth three times a day and wear masks when dressing was carried out.The incidence rates of tunnel stomatitis and peritonitis and lengths of hospital stay were recorded.The purulent secretions that were collected from the patients with tunnel stomatitis were cultured,the drug susceptibility testing was performed,the effluent dialysates that remained in abdomen of the patients with peritonitis for more than 4 hours were collected for conventional examination and culture of peritoneal dialysates,and the drug susceptibility testing was performed.RESULTS The incidence rates of tunnel stomatitis and peritoneal dialysis-related peritonitis of the observation group were significantly lower than those of the control group,and the length of hospital stay of the patients with peritoneal dialysis-related peritonitis was significantly shorter in the observation group than in the control group（P〈0.05）.The effluent dialysates specimens were cultured positive in 32 of 36 patients with peritonitis,with the positive rate 88.89%.Totally 35 strains of pathogens were isolated,and two species of pathogens were cultured from 3 patients.Among the 35 strains of pathogens,there were 19（54.29%）strains of gram-positive bacteria and 16（45.71%）strains of gram-negative bacteria.The drug resistance rates of the gram-posi

关 键 词：腹膜透析 腹膜炎感染 莫匹罗星 药敏 

分 类 号：R378[医药卫生—病原生物学]