腹膜透析患者腹透液标本的病原菌分布及耐药性分析  

作　　者：尤伟波[1] 李慧霞[1] 丁卉[1] 任建敏[1] 黄建胜[1] 

机构地区：[1]浙江省丽水市中心医院,323000

出　　处：《浙江临床医学》2021年第10期1507-1509,共3页Zhejiang Clinical Medical Journal

基　　金：丽水市科技局重点学科项目(2016zdxk06)。

摘　　要：目的探讨腹膜透析患者腹透液标本中的细菌培养阳性情况、细菌分布情况及其耐药性。方法回顾性分析2010年至2019年本院389份腹透液标本的细菌分布情况和耐药性,药敏试验采用K-B法和MIC法,判读标准参照CLSI的规定。结果389份腹透液标本中细菌培养阳性标本162份(41.65%)。其中,革兰阴性菌占38.27%,革兰阳性菌占58.02%,真菌占3.09%,抗酸杆菌占0.62%。主要的阴性菌为大肠埃希菌(23.46%)、肺炎克雷伯菌(6.17%)、阴沟肠杆菌(3.09%)。主要的阳性菌为表皮葡萄球菌(17.90%)、缓症链球菌(9.88%)、肠球菌(4.94%)、溶血葡萄球菌(4.94%)、金黄色葡萄球菌(3.70%)。主要的真菌为白念珠菌(1.23%)、热带念珠菌(1.23%)。其他,有抗酸杆菌(0.62%)。革兰阴性菌中氨苄西林、复方新诺明、头孢呋辛、左氧氟沙星、氨曲南、庆大霉素、头孢噻肟的耐药率均在20%以上,未检出对美罗培南和亚胺培南的耐药菌株,酶抑制剂复合制剂类抗菌药物有较低的耐药率,均在5%以下。革兰阳性菌中青霉素、红霉素、克林霉素、头孢西丁、环丙沙星、复方新诺明、左氧氟沙星的耐药率均在20%以上,未检出对万古霉素、利奈唑胺、替考拉宁及替加环素的耐药菌株。结论腹膜透析相关性感染应尽早送检腹透液标本,明确病原菌后选用敏感抗菌药物进行治疗,可提高治疗效果、改善患者预后。Objective To investigate the positive conditions of bacterial culture specimens in patients with peritoneal dialysis,and the distribution of bacteria and its dmg resistance.Methods Retrospective analysis of bacterial distribution and drug resistance of 389 abdominal specimens in 2010 to 2019,the dmg sensitization test uses the K-B method and MIC method,and the criteria should be used to refer to CLSI regulations.Results Among 389 peritoneal dialysis specimens,162(41.65%)were positive for bacterial culture.Among them,38.27% of Gram-negative bacteria,58.02% Gram-positive bacteria,3.09% fungi and 0.62% of acid resistant bacteria.The main negative bacteria were Escherichia coli 23.46%,Klebsiella pneumoniae 6.17%,Enterobacter cloacae 3.09%.The main positive bacteria were Staphylococcus epidermidis(17.90%),Streptococcus mitis(9.88%),Enterococcus(4.94%),Staphylococcus haemolyticus(4.94%)and Staphylococcus aureus(3.70%).The main fungi were Candida albicans(1.23%),Candida tropicalis(1.23%).other acid fast bacilli accounted for 0.62%.In Gram-negative bacteria,the drug resistance rates of ampicillin,sulfamethoxazole,cefuroxime,levofloxacin,aztreonam,gentamicin and cefotaxime were all above 20%.No resistant strains to meropenem and imipenem were detected.The drug resistance rate of enzyme inhibitor compound preparation was lower than 5%.In Gram-positive bacteria,the drug resistance rates of penicillin,erythromycin,clindamycin,cefoxitin,ciprofloxacin,sulfamethoxazole and levofloxacin were all above 20%.No resistant strains to vancomycin,linezolid,teicoplanin and tigecycline were detected.Concision Peritoneal dialysis relevance infection should be given as soon as possible,and the treatment of sensitive antibacterial drugs will be used to use sensitive antibacterial drugs,improve the treatment effect,and improve patient prognosis.

关 键 词：腹透液 病原菌 耐药性 腹膜透析相关性感染 

分 类 号：R44[医药卫生—诊断学]