腹膜透析相关性腹膜炎患者感染病原菌特点分析  

Characteristics of pathogens causing infections in patients with peritoneal dialysis-related peritonitis

作　　者：赵馥 杨金国[2] 糜彩霞 陈逸菲 余福海 

机构地区：[1]宁波市奉化区人民医院肾内科,浙江宁波315500 [2]宁波市医疗中心李惠利医院肾内科,浙江宁波315041

出　　处：《中华医院感染学杂志》2017年第18期4167-4170,共4页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生一般研究计划(2015KYA025)

摘　　要：目的分析腹膜透析相关性腹膜炎患者感染革兰阳性菌与革兰阴性菌的特点。方法选择医院2006年1月-2016年12月腹膜透析相关性腹膜炎革兰阳性菌感染患者32例作为革兰阳性菌组,腹膜透析相关性腹膜炎革兰阴性菌感染患者56例作为革兰阴性菌组,回顾性分析患者的发热、腹透液性状、腹痛等临床资料及实验室检查结果、病原菌培养和药敏结果。结果革兰阳性菌组和革兰阴性菌组患者发热、腹透液性状、腹痛比较差异无统计学意义;革兰阳性菌组中性粒细胞数、C-反应蛋白、透析液有核细胞数、透析液中性粒细胞比例均低于革兰阴性菌组(P<0.05),革兰阳性菌组血清钾高于革兰阴性菌组(P<0.05),两组血清尿素氮、血肌酐、血清钠、血清氯、血清钙、血清磷指标比较差异无统计学意义;革兰阳性菌组感染病原菌以表皮葡萄球菌、金黄色葡萄球菌为主,分别占46.9%、18.8%,革兰阴性菌组感染病原菌以大肠埃希菌、肺炎克雷伯菌为主,分别占39.3%、19.6%;表皮葡萄球菌和金黄色葡萄球菌对苯唑西林和红霉素耐药率较高,耐药率分别为73.3%、80.0%,83.3%、66.7%,对利奈唑胺、万古霉素、替考拉宁的耐药率均为0;大肠埃希菌和肺炎克雷伯菌对氨苄西林的耐药率较高,耐药率分别为77.3%、72.7%,对阿米卡星、亚胺培南、头孢哌酮/舒巴坦的耐药率均为0。结论腹膜透析相关性腹膜炎革兰阳性菌感染患者C-反应蛋白和中性粒细胞水平较低,血清钾水平较高,主要以表皮葡萄球菌、金黄色葡萄球菌感染为主,对红霉素、苯唑西林耐药性高,腹膜透析相关性腹膜炎革兰阴性菌感染以大肠埃希菌和肺炎克雷伯菌为主,对氨苄西林耐药性较高。OBJECTIVE To analyze the characteristics of gram-positive bacteria and gram-negative bacteria causing infections in patients with peritoneal dialysis-related peritonitis.METHODS Totally 32 patients with peritoneal dialysis-related peritonitis caused by gram-positive bacteria who were treated in the hospital from Jan 2006 to Dec 2016 were chosen as the gram-positive bacteria group,and 56 patients with peritoneal dialysis-related peritonitis caused by gram-negative bacteria were assigned as the gram-negative bacteria group.The clinical data including fever,peritoneal fluid turbidity and abdominal pain,results of laboratory examinations,culture of pathogens and result of drug susceptibility testing were retrospectively analyzed.RESULTS There was no significant difference in the fever,peritoneal fluid turbidity,or abdominal pain between the gram-positive bacteria group and the gram-negative bacteria group.The neutrophils counts,C-reactive protein,nucleated cells counts in dialysates and the proportion of neutrophils in dialysates were lower in the gram-positive bacteria group than in the gram-negative bacteria group（P〈0.05）.The serum potassium level of the gram-positive bacteria group was higher than that of the gram-negative bacteria group（P〈0.05）.There was no significant difference in the serum urea nitrogen,serum creatinine,serum sodium,serum chlorine,serum calcium or serum phosphorus between the two groups.Staphylococcus epidermidis and Staphylococcus aureus were the predominant species of pathogens in the gram-positive bacteria group,accounting for 46.9% and 18.8% ,respectively.Escherichia coli and Klebsiella pneumoniae were dominant among the pathogens in the gram-negative bacteria group,accounting for 39.3% and 19.6% ,respectively.The drug resistance rates of the S.epidermidis to oxacillin and erythromycin were 73.3% and 80.0% ,respectively;the drug resistance rates of the S.aureus to oxacillin and erythromycin were 83.3% and 66.7% ,respectively;the drug resistance rates to linezolid,vancomycin and

关 键 词：腹膜透析 腹膜炎 革兰阳性菌 革兰阴性菌 

分 类 号：R572.2[医药卫生—消化系统]