711例次腹膜透析相关性腹膜炎的致病菌谱变化及药物敏感分析  

Analysis of microbiological trends and antibiotic susceptibility in 711 episodes of peritoneal dialysis- related peritonitis

作　　者：佟怡婧 严豪[1] 李振元[1] 黄佳颖[1] 顾爱萍[1] 倪兆慧[1] 方炜[1] 

机构地区：[1]上海交通大学医学院附属仁济医院肾脏科,上海市腹膜透析研究中心,200127

出　　处：《中华肾脏病杂志》2017年第8期601-608,共8页Chinese Journal of Nephrology

基　　金：基金项目：国家自然科学基金（81370814、81670691）;上海市教育委员会高峰高原学科建设计划（20152211）

摘　　要：目的探讨腹膜透析（腹透）相关性腹膜炎（PDAP）致病菌谱和药物敏感（药敏）性变化，为临床合理防治PDAP提供依据。方法病例来自2004年1月1日至2015年12月31日期间上海交通大学医学院附属仁济医院腹透中心随访患者中所有发生PDAP的患者。采集患者人口统计学资料、透出液致病菌培养及药敏试验结果。分别按照透出液培养结果和腹膜炎发生年代分组。用Poisson回归法进行腹膜炎发生率的趋势检验分析，用x^2检验或Fisher确切概率法比较不同时间段致病菌谱的构成及药物敏感率的差异。结果12年间共有386例患者发生711例次PDAP。透出液致病菌培养阳性率由2004年的52．0％提高至2015年的77．0％（P〈0．001）。培养阳性的腹膜炎中，革兰阳性菌腹膜炎270例次（59．5％），革兰阴性菌腹膜炎129例次（28．4％），混合感染39例次（8．6％），真菌性腹膜炎15例次（3．3％），分枝杆菌腹膜炎1例次（0．2％）。腹膜炎发生率由2004年的0．214例次／患者·年下降至2015年的0．160例次／患者·年（P=0．034）。凝固酶阴性葡萄球菌相关腹膜炎的发生率由2004—2005年0．049例次／患者·年下降至2014—2015年的0．027例次／患者·年（P=0．025），其余致病菌腹膜炎发生率的比较差异无统计学意义。与2004—2009年组相比，2010—2015年组患者革兰阳性菌对第一代头孢菌素及氨苄西林／舒巴坦敏感率显著下降（613％比88．2％，P〈0．001；61．7％比85．5％，P=0．001），对万古霉素敏感率两组差异无统计学意义。2004—2009年组与2010—2015年组间革兰阴性菌对头孢他啶及阿米卡星的敏感率比较差异无统计学意义。采用头孢拉定作为初治用药的革兰阳性菌腹膜炎，与2004—2009年组相比，2010—2015年组需要调整治疗方案的患者比例显著升高，治愈患者的疗程延长。结论PDAP的发生率较前明显�Objective To investigate the microbiological trends and antibiotic susceptibility of peritoneal dialysis（PD）-related peritonitis （PDAP）. Methods All patients who developed PDAP between 2004 and 2015 in Renji Hospital, Shanghai Jiao Tong University School of Medicine were enrolled. Demographic data, results of dialysate pathogen culture and drug susceptibility test were recorded. The trend of peritonitis incidence was measured by Poisson regression and the chi-square test or Fisher exact test method was used to compare the composition of causative organisms and their antimicrobial susceptibilities over time. Results During the study period, a total of 711 episodes of PDAP were occurred in 386 patients. The culture positive rate of pathogens rose from 52.0% in 2004 to 77.0% in 2015 （P 〈 0.001）. The distribution of causative organisms of the culture positive peritonitis was gram- positive bacteria （270, 59.5% ）, followed by gram- negative bacteria （129, 28.4% ）, polymicrobial（39, 8.6%）, fungi （15, 3.3%） and mycobacteria （1, 0.2%）. From 2004 to 2015, the incidence of peritonitis decreased from 0.214 to 0.160 episodes/patient＇year （P=0.034）. The incidence of coagulase-negative staphylococcus peritonitis decreased from 0.049 to 0.027 episodes/patient ~ year （P=0.025）, while others had no significant change; A significant decline was observed in the sensitivity of Gram-positive strains to the first generation cephalosporin and ampicillin/sulbactam in 2010-2015 group compared with those in 2001-2009 group （61.3% vs 88.2%, P 〈 0.001; 61.7% vs 85.5%, P= 0.001）, whereas the sensitivity to vancomycin remained the same. The sensitivity of Gram- negative strains to ceftazidime and amikacin showed no significant change. As for the gram-positive peritonitis treated with cefradine as empirical treatment, compared with those in 2004-2009 group, in 2010-2015 group the proportion of patients requiring to change their treatment regime was significantly higher, and the treatment course

关 键 词：腹膜透析 腹膜炎 致病菌 药敏试验 

分 类 号：R572.2[医药卫生—消化系统] R692.5[医药卫生—内科学]