单中心腹膜透析相关性腹膜炎的病原菌及耐药性分析  

A single-center study of pathogenic bacteria and drug resistance in peritoneal dialysis-associated peritonitis

作　　者：高俊丽 李丽[1] 刘琨[1] GAO Junli;LI Li;LIU Kun(Department of Nephrology,Jinshan Branch of Shanghai Sixth People’s Hospital,Shanghai 201599,China)

机构地区：[1]上海市第六人民医院金山分院肾脏科,201599

出　　处：《河北医药》2023年第19期3018-3021,3025,共5页Hebei Medical Journal

基　　金：上海市卫健委临床专项课题(编号:20214Y0144);上海市第六人民医院金山分院院级课题(编号:2020-7);周锦明上海市名老中医学术经验研究工作室(编号:SHGZS-202237)。

摘　　要：目的对单中心腹膜透析相关性腹膜炎(peritoneal dialysis-associated peritonitis,PDAP)致病菌分布特点及耐药性进行分析,为PDAP抗生素选择提供指导,提高其治愈率。方法收集金山分院2017年1月至2019年9月PDAP患者的临床资料,进行统计分析。结果在87例PDAP患者中,2次及2次以上感染者62例(71.26%)。透析液致病菌培养阳性55例次(63.22%),其中革兰氏阳性菌35株(57.38%),主要为表皮葡萄球菌9例(25.71%),粪肠球菌6例(17.14%);革兰氏阴性菌26例(42.62%),主要为大肠埃希菌8例(32%),洛菲不动杆菌6例(24%);混合感染6例,无真菌感染,其中7~9月份发病率明显增高(33.33%)。革兰氏阳性菌对达托霉素敏感,未发现有耐药病例。对利奈唑胺、万古霉素敏感性均较高,对氨苄西林/舒巴坦(70%)、阿莫西林/克拉维酸(70%)、氨苄西林(72.41%)、头孢曲松(73.91%)、苯唑青霉素(72.73%)、青霉素(79.41%)耐药。革兰氏阴性菌对米诺环素、阿卡米星、链霉素、头孢替坦敏感,未发现有耐药病例,对氨苄西(38.46%)、复方磺胺甲恶唑(39.13%)、环丙沙星(40.74%)耐药。结论该中心PDAP致病菌以革兰氏阳性菌最为常见,7~9月份为发病率最高,需加强宣教,注意肠道卫生,降低发病率。腹透液致病菌培养阳性率较低,需加强宣教,带最混浊腹透液就医,提高腹透液培养阳性率。达托霉素、利奈唑胺、万古霉素可作为革兰氏阳性菌PDAP的治疗首选,革兰氏阴性菌可选择米诺环素、阿卡米星、链霉素、头孢替坦。Objective To analyze the distribution characteristics and drug resistance in peritoneal dialysis-associated peritonitis(PDAP)in a single center,so as to provide guidance for the selection of antibiotics and increase in the cure rate of PDAP.Methods The clinical data of PDAP patients treated in our center from January 2017 to September 2019 were collected and statistically analyzed.Results Among 87 PDAP patients,62 cases(71.26%)were infected twice or more.There were 55 positive dialysate cultures(63.22%),including 35 Gram-positive bacteria(57.38%),in which Staphylococcus epidermidis(9 cases,25.71%)and Enterococcus faecalis(6 cases,17.14%)were the major bacteria.Gram-negative bacteria were found in 26 cases(42.62%),which were mainly Escherichia coli(8 cases,32%)and Acinetobacter roffei(6 cases,24%).There were 6 cases of mixed infection,but no fungal infection was detected.The incidence of fungal infection increased significantly from July to September(33.33%).Gram-positive bacteria were sensitive to daptomycin,and no drug-resistant cases were found.They were highly sensitive to linezolid and vancomycin,but resistant to ampicillin/sulbactam(70%),amoxicillin/clavulanate(70%),ampicillin(72.41%),ceftriaxone(73.91%),oxacillin(72.73%)and penicillin(79.41%).Gram-negative bacteria were sensitive to minocycline,amikacin,streptomycin and cefotetan,but resistant to ampicillin(38.46%),trimethoprim-sulfamethoxazole(39.13%)and ciprofloxacin(40.74%).Conclusion Gram-positive bacteria are the most common pathogenic bacteria of PDAP in our center,and its incidence is highest from July to September.It is necessary to strengthen health education and intestinal hygiene to reduce the incidence of PDAP.The positive rate of peritoneal dialysate culture is low.It is necessary to strengthen propaganda and education.The most turbid peritoneal dialysate contributes to improve the positive rate of peritoneal dialysate culture.Daptomycin,linezolid and vancomycin can be used as the first choice for the treatment of Gram-positive bacteria PDAP,an

关 键 词：腹膜透析 腹膜透析相关性腹膜炎 病原菌 耐药性 抗生素 

分 类 号：R978.1[医药卫生—药品]