鲍曼不动杆菌腹膜透析相关性腹膜炎10例  

Acinetobacter baumannii peritoneal dialysis-related peritonitis:a review of 10 cases

作　　者：田秀娟 何娟 杨君 柳红昌 TIAN Xiujuan;HE Juan;YANG Jun;LIU Hongchang(Department of Nephrology,the First Affiliated Hospital,Airforce Military University,Xi’an,Shaanxi 710032,P.R.China;Department of Anesthesiology,the First Affiliated Hospital,Airforce Military University,Xi’an,Shaanxi 710032,P.R.China)

机构地区：[1]空军军医大学第一附属医院肾脏内科,西安710032 [2]空军军医大学第一附属医院麻醉科,西安710032

出　　处：《华西医学》2021年第4期483-487,共5页West China Medical Journal

基　　金：国家自然科学基金(81700676)。

摘　　要：目的探讨鲍曼不动杆菌腹膜透析相关性腹膜炎患者的临床特点、治疗及转归。方法回顾性分析空军军医大学第一附属医院2011年1月—2018年12月收治的鲍曼不动杆菌腹膜透析相关性腹膜炎患者的临床资料,包括基线临床资料、微生物培养及药物敏感性(药敏)结果、治疗经过及临床结局。结果共纳入10例患者,男4例,女6例;患者平均年龄(44.90±17.03)岁,平均腹膜透析龄(21.70±17.06)个月;首次感染7例,多次发生腹膜透析相关性腹膜炎3例;腹膜透析感染因素主要为导管连接系统机械故障(3例)和肠源性感染(3例);主要症状为腹痛(10例)、发热(7例)、腹泻(3例);入院后给予经验性头孢唑林和头孢他啶抗感染治疗,仅1例有效,余9例根据药敏结果调整,药敏结果提示鲍曼不动杆菌对头孢哌酮、碳青霉烯类(美罗培南、亚胺培南)、喹诺酮类(环丙沙星、左氧氟沙星)、氨基糖苷类(庆大霉素)及多黏菌素均敏感,仅1例对头孢他啶耐药;8例治愈,1例死亡,1例拔除腹膜透析管改为血液透析。结论该院鲍曼不动杆菌腹膜透析相关性腹膜炎多由导管连接系统机械障碍或肠源性感染引起,应采取适当措施,包括无菌规范操作、随访和积极有效的抗感染治疗,以降低腹膜透析患者鲍曼不动杆菌腹膜炎的发生率和死亡率。Objective To investigate the clinical characteristics,treatment and outcomes of patients with Acinetobacter baumannii peritoneal dialysis-related peritonitis.Methods We retrospectively analyzed the clinical data of patients with Acinetobacter baumannii peritoneal dialysis-related peritonitis in the First Affiliated Hospital of Airforce Military University from January 2011 to December 2018.The clinical baseline data,treatment process,microbiological data,antibiotic susceptibility test of the bacterial isolates and outcomes were analyzed.Results A total of 10 patients were enrolled,including 4 males and 6 females.The average age of all patients was(44.90±17.03)years,the average age of peritoneal dialysis was(21.70±17.06)months.Seven cases were infected for the first time,and 3 cases were reinfected.The infections were mainly caused by mechanical failure of catheter connection system(3 cases)or enterogenous infection(3 cases).The main symptoms were abdominal pain(10 cases),fever(7 cases)and diarrhea(3 cases).Empirical antiinfective treatment was given after admission,only 1 case was effective,and the treatment of the other 9 cases were adjusted according to the results of drug sensitivity.Acinetobacter baumannii was sensitive to cefoperazone,carbapenem(meropenem,imipenem),quinolones(ciprofloxacin,levofloxacin),aminoglycosides(gentamicin)and polymyxin.Only one case was resistant to ceftazidime.Among the 10 patients,8 cases were cured(continued peritoneal dialysis),1 case died,and 1 case dropped out from peritoneal dialysis to hemodialysis.Conclusions Acinetobacter baumannii peritoneal dialysisrelated peritonitis in this hospital is mainly caused by mechanical disturbance of catheter connection system or enterogenic infection.Appropriate measures,including aseptic standard operation,follow-up and effective anti-infective treatment,should be taken to decrease the incidence and mortality of Acinetobacter baumannii peritoneal dialysis-related peritonitis.

关 键 词：鲍曼不动杆菌 腹膜透析相关性腹膜炎 耐药性 

分 类 号：R692.5[医药卫生—泌尿科学] R572.2[医药卫生—外科学]