传统法与改良法培养腹膜透析相关性腹膜炎病原菌阳性率的比较及耐药性分析  

Comparison of positive rate of peritoneal dialysis-associated peritonitis pathogens cultured by traditional method and modified method and analysis of drug resistance

作　　者：陈春苗 许志辉 王菲菲 云晓滢 李冰 Chen Chunmiao;Xu Zhihui;Wang Feifei;Yun Xiaoying;Li Bing(Department of Nephrology,the Second Affiliated Hospital of Hainan Medical College,Haikou 570216,China)

机构地区：[1]海南医学院第二附属医院肾内科,海口570216

出　　处：《中华肾脏病杂志》2024年第4期300-304,共5页Chinese Journal of Nephrology

基　　金：国家自然科学基金(82370697);海南省重点研发项目(ZDYF2020126)。

摘　　要：该研究为回顾性队列研究。收集2021年1月1日至2022年12月31日在海南医学院第二附属医院肾内科确诊为腹膜透析相关性腹膜炎(peritoneal dialysis-associated peritonitis,PDAP)患者腹膜透析透出液样本,根据腹膜炎发生时间不同分为传统法组(2021年)和改良法组(2022年)。传统法组仅采用传统法进行病原菌培养,改良法组同时采用传统法和改良法进行病原菌培养。分析病原菌培养阳性率、培养阳性时间、病原菌谱及耐药情况。结果显示,共223例(324例次)PDAP患者被纳入该研究,传统法组115例(168例次),改良法组108例(156例次)。改良法病原菌培养阳性率显著高于传统法[84.62%(132/156)比69.23%(108/156),χ^(2)=18.903,P<0.001],病原菌培养阳性时间短于传统法[69.0(58.0,90.9)h比79.5(65.6,90.2)h,Z=2.061,P=0.039]。传统法组共培养病原菌120株,其中革兰阳性(G+)菌69株(57.50%),革兰阴性(G-)菌46株(38.33%),真菌5株(4.17%);G+菌中常见菌株为表皮葡萄球菌(17株,14.17%)和唾液链球菌(10株,8.33%)。改良法组共培养病原菌134株,其中G+菌106株(79.10%),G-菌24株(17.91%),真菌4株(2.99%);G+菌中常见菌株为唾液链球菌(20株,14.93%)和表皮葡萄球菌(15株,11.19%)。G+菌对苯唑西林的耐药率最高(50/85,58.82%),G-菌对氨苄西林的耐药率最高(21/35,60.00%),真菌仅对氟康唑耐药(1/9,11.11%)。提示改良法可提高腹膜透析透出液病原菌培养阳性率,缩短培养时间;G+球菌为本中心PDAP的主要致病菌;苯唑西林和氨苄西林不宜作为本中心治疗PDAP的首选用药。It was a retrospective cohort study.Peritoneal dialysis exudate samples from patients diagnosed with peritoneal dialysis-associated peritonitis(PDAP)in the Nephrology Department of the Second Affiliated Hospital of Hainan Medical College from January 1,2021 to December 31,2022 were collected.Based on different time of peritonitis,the specimens were split into two groups:the traditional method group and the modified method group.Only the traditional method was used for pathogen culture in the traditional method group.Both the traditional method and modified method were used for pathogen culture in the modified method group.The rates of positive culture of pathogenic bacteria,duration required to obtain positive culture results,spectrum of pathogenic bacteria,and drug resistance were analyzed.The results showed that a total of 223 patients(324 cases)with PDAP were included in the study,including 115 patients(168 cases)in the traditional method group and 108 patients(156 cases)in the modified method group.The modified method group displayed a significantly higher rate of pathogenic bacteria than the traditional method group[84.62%(132/156)vs.69.23%(108/156),χ^(2)=18.903,P<0.001].Additionally,the modified method group required less time to achieve a positive culture result of pathogenic bacteria than the traditional method group[69.0(58.0,90.9)h vs.79.5(65.6,90.2)h,Z=2.061,P=0.039].In this study,120 culture-positive pathogens were identified in the traditional method group,of which,69(57.50%)were Gram-positive,46(38.33%)were Gram-negative,and 5(4.17%)were fungi;The common strains of Gram-positive bacteria were staphylococcus epidermidis(17 strains,14.17%)and streptococcus salivarius(10 strains,8.33%).There were 134 culture-positive pathogens identified in the modified method group,of which 106(79.10%)were Gram-positive,24(17.91%)were Gram-negative,and 4(2.99%)were fungi;The common strains of Gram-positive bacteria were streptococcus salivarius(20 strains,14.93%)and staphylococcus epidermidis(15 strains,11.19%).Gram-

关 键 词：腹膜透析 腹膜炎 抗药性 细菌 病原菌 培养方法 

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