单中心腹膜透析相关性腹膜炎的致病菌及其药物敏感分析  

Pathogens and Drug Sensitivity Analysis of Peritonitis Associated With Single-peritoneal Dialysis

作　　者：何玉 HE Yu(Department of Nephrology,Chizhou People's Hospital,ChizhouAnhui 247000,China)

机构地区：[1]池州市人民医院肾内科,安徽池州247000

出　　处：《中国卫生标准管理》2022年第2期36-39,共4页China Health Standard Management

摘　　要：目的探讨池州市人民医院腹膜透析相关性腹膜炎的发病原因、致病菌及转归预后的情况,为本中心腹膜透析相关性腹膜炎的防治提供科学依据。方法回顾性分析池州市人民医院2015年9月—2019年12月收治的接受腹膜透析并发生腹膜透析相关性腹膜炎92例患者的临床资料,分析发生腹膜透析相关性腹膜炎的原因、致病菌、预后和转归状况。结果腹膜炎发生的主要原因包括腹膜透析操作不规范27例(29.34%),肠道感染10例(10.87%),呼吸道感染6例(6.52%),原因不明49例(53.26%)。腹膜透析液培养阳性56例,阳性率为60.87%,其中G^(+)菌30例(53.57%),G^(-)菌22例(39.29%),真菌4例(7.14%)。G^(+)菌主要以表皮葡萄球菌(10例)为主,其次为金黄色葡萄球菌(5例)及溶血性葡萄球菌(4例)。G^(-)菌主要以大肠埃希菌(10例)为主,其次为肺炎克雷伯杆菌(6例)。真菌主要以白假丝酵母菌(3例)为主,其次为热带假丝酵母菌(1例)。培养阳性者行致病菌耐药分析,G^(+)菌对万古霉素、利奈唑胺及达托霉素均敏感,主要对氨苄西林(82.61%)、青霉素(73.08%)及头孢曲松(69.57%)耐药。G^(-)菌主要对碳氢酶烯类及阿米卡星菌敏感,未发现有耐药病例。G^(-)菌主要对氨苄西林(90.00%)、氨苄西林舒巴坦(66.67%)及头孢噻肟(35.00%)耐药。真菌感染对氟康唑、伊曲康唑、伏立康唑及两性霉素均敏感。G^(+)菌性腹膜炎治愈率明显高于真菌性腹膜炎,差异有统计学意义(P<0.05);与G^(-)菌性腹膜炎及培养阴性腹膜炎治愈率比较,差异无统计学意义(P>0.05)。真菌性腹膜炎退出率明显高于G^(+)菌性、G^(-)菌性及培养阴性腹膜炎,差异有统计学意义(P<0.05)。结论本中心腹膜透析患者发生腹膜透析相关性腹膜炎的主要原因为换液操作不规范和肠道感染,致病菌主要为G^(+)菌。真菌性腹膜炎退出率较高,治愈率较低,预后差。Objective To investigate the causes,pathogenic bacteria and prognosis of peritonitis associated with peritoneal dialysis in Chizhou People's Hospital,so as to provide a scientific basis for the prevention and treatment of peritonitis associated with peritoneal dialysis in the center.Methods The clinical data of 92 patients with peritoneal dialysis and peritoneal dialysis related peritonitis treated in Chizhou people's Hospital from September 2015 to December 2019 were analyzed retrospectively And analyzed the causes,pathogenic bacteria,prognosis and outcome of peritonitis associated with peritoneal dialysis.Results The main causes of peritonitis included 27 cases(29.34%)of irregular peritoneal dialysis operations,10 cases of intestinal infection(10.87%),6 cases of respiratory infection(6.52%),and 49 cases(53.26%)of unknown cause.Peritoneal dialysate culture was positive in 56 cases,with a positive rate of 60.87%,of which 30 cases were G^(+) bacteria(53.57%),22 cases were G^(-) bacteria(39.29%),and 4 cases were fungi(7.14%).G^(+) bacteria were mainly Staphylococcus epidermidis(10 cases),followed by Staphylococcus aureus(5 cases)and Staphylococcus hemolyticus(4 cases).G^(-) bacteria are mainly Escherichia coli(10 cases),followed by Klebsiella pneumoniae(6 cases).The main fungus is Candida albicans(3 cases),followed by Candida tropicalis(1 case).Those with positive cultures were analyzed for resistance of pathogenic bacteria.Among G^(+) bacteria,they were all sensitive to vancomycin,linezolid and daptomycin,mainly to ampicillin(82.61%),penicillin(73.08%)and ceftriaxone(69.57%)drug resistance.G^(-) bacteria are mainly sensitive to hydrocarbons and amikacin,and no dru G^(-) resistant cases have been found.G^(-) bacteria are mainly resistant to ampicillin(90.00%),ampicillin and sulbactam(66.67%)and cefotaxime(35.00%).Fungal infections are sensitive to fluconazole,itraconazole,voriconazole and amphotericin.The cure rate of G^(+) bacterial peritonitis was significantly higher than that of fungal peritonitis(P<0.05);there

关 键 词：腹膜透析相关性腹膜炎 G^(+)菌 G^(-)菌 真菌 药敏试验 治愈率 

分 类 号：R459[医药卫生—治疗学]