腹膜透析相关性腹膜炎的病原菌菌谱及耐药性分析  

Analysis of Bacterial Spectrum and Drug Resistance of Pathogens in Peritoneal Dialysis-associated Peritonitis

作　　者：林强 俞国庆[1] 黄翠红 庄永泽[1] LIN Qiang;YU Guoqing;HUANG Cuihong(Department of Nephrology,900 Hospital of the Joint Logistics Team,PLA,Fuzhou General Clinical Medical College of Fujian Medical University,Fuzhou,350025)

机构地区：[1]中国人民解放军联勤保障部队第九○○医院,福建医科大学福总临床医学院肾脏病科,福州350025

出　　处：《中国中西医结合肾病杂志》2023年第9期782-785,共4页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：福建省临床重点专科建设项目(No.2017ZDZKSB);福建省免疫性慢性肾病临床医学研究中心基金资助项目(No.2021Y2016)。

摘　　要：目的:分析本中心腹膜透析相关性腹膜炎(peritoneal dialysis-associated peritonitis,PDAP)的致病菌谱及其对常用抗生素的耐药性情况,为治疗提供依据。方法:回顾性总结分析本中心2010年01月—2019年12月的持续不卧床腹膜透析(CAPD)236例患者中发生PDAP的腹膜透析透出液病原学培养及药敏结果。结果:331例次PDAP腹膜透析透出液标本,病原菌培养阳性193例次,培养阴性138例次,阳性率58.51%,其中革兰氏阳性菌(G^(+)菌)136株(70.47%),以表皮葡萄球菌、溶血葡萄球菌、金黄色葡萄球菌为主;革兰氏阴性菌(G^(-)菌)42株(21.76%),以大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌为主;真菌15株(7.77%)。G^(+)菌对青霉素、头孢唑林钠、左氧氟沙星的耐药率分别为70.16%、62.50%、38.28%,对万古霉素、利奈唑胺、替考拉宁敏感率分别为99.22%、99.15%、98.65%。G^(-)菌对头孢曲松、哌拉西林、头孢噻肟的耐药率分别为28.57%、29.03%、25.00%;对莫西沙星、哌拉西林/他唑巴坦、美罗培南敏感率分别为100%、100%、96.93%。331例次PDAP治疗后262例次治愈(79.15%),64例拔管转为血液透析,5例死亡。结论:PDAP是PD常见退出主要原因之一,G^(+)菌为主要致病菌,以万古霉素首选,G^(-)菌则可选用第三代头孢霉素类、哌拉西林/他唑巴坦或碳青霉烯类抗生素。定期分析病原菌分布及耐药率、敏感率,可指导临床药物选择。Objective:To investigate the microbial spectrum and antibiotic resistance of continuous ambulatory peritoneal dialysis(CAPD)associated peritonitis(PDAP)in our centre and guide the clinical rational use of antimicrobial agents.Methods:The etiological culture results of peritoneal peritonitis in patients with CAPD from January 2010 to December 2019 in our center were reviewed,and the pathogenic bacteria spectrum and drug resistance to common antibiotics were analyzed.Results:In 331 cases of PD-Associated peritonitis,193 cases were positive for pathogen culture,with a positive rate of 58.51%Among them,136 strains(70.47%)of gram-positive bacteria were mainly Staphylococcus epidermidis,Staphylococcus haemolyticus and Staphylococcus aureus.There were 42 gram-negative strains(21.76%),mainly escherichia coli,Pseudomonas aeruginosa and Klebsiella pneumoniae.There were 15 strains of fungi(7.77%).The resistance rates of gram-positive bacteria to penicillin,cefazolin sodium and levofloxacin were 70.16%,62.50%and 38.28%,respectively,and the sensitivity rates to vancomycin,linezolid and teicoranin were 99.22%,99.15%and 98.65%,respectively.The drug resistance rates of gram-negative bacteria to ceftriaxone,piperacillin and cefotaxime were 28.57%,29.03%and 25.00%,respectively.The sensitivity rates of moxifloxacin,piperacillin tazobactam and meropenem were 100%,100%and 96.93%,respectively.Among 331 cases of PDAP,262 cases(79.15%)were cured after treatment,64 cases were extubated and transferred to hemodialysis,5 case died.Conclusion:Peritonitis is one of the common causes of PD withdrawal.The pathogenic bacteria were mainly Gram-positive bacteria.Vancomycin is the first choice.The third generation cephalosporins,piperacillin/tazobactam or carbapenem antibiotics can be selected for treatment of gram-positive bacteria.Periodic analysis of the distribution of pathogenic bacteria,drug resistance rate and sensitivity rate can guide the selection of clinical drugs.

关 键 词：腹膜透析 腹膜透析相关性腹膜炎 病原菌 耐药性 

分 类 号：R692.5[医药卫生—泌尿科学] R446.5[医药卫生—外科学]