某医院腹膜透析相关腹膜炎临床病原学特征及抗菌药物合理性应用评价  

Clinical pathogenic characteristics of peritoneal dialysis-associated peritonitis and rational use evaluation of antibiotics in a hospital

作　　者：邓一脉 陈蕊欢 Deng Yimai;Chen Ruihuan(Clinical Microbiology Laboratory,Changshu Institution of Laboratory Medicine,Changshu 215500,Jiangsu,China;Department of Pharmacy,Changshu Hospital Affiliated to Soochow University,Changshu 215500,Jiangsu,China)

机构地区：[1]常熟市医学检验所临床微生物实验室,江苏常熟215500 [2]苏州大学附属常熟医院药剂科,江苏常熟215500

出　　处：《实用检验医师杂志》2025年第1期23-26,共4页Chinese Journal of Clinical Pathologist

基　　金：江苏省常熟市卫生健康委资助重点项目(CSWS202226);江苏省苏州市科技发展计划项目(SKYD2023169)。

摘　　要：目的分析江苏省常熟市某市级医院腹膜透析相关腹膜炎(PDAP)的病原学特征,评价抗菌药物选择的合理性,为临床治疗提供参考。方法回顾并收集2018—2023年苏州大学附属常熟医院收治的46例PDAP患者的临床资料,分析患者的临床体征、实验室指标、病原菌分布、药敏试验结果以及抗感染治疗方案。结果46例患者发生56例次PDAP,临床表现以腹痛、腹透液浑浊、发热为主。56例次PDAP分离培养出43株病原菌,其中革兰阳性(G^(+))菌33株(占76.74%),以葡萄球菌属为主;革兰阴性(G-)菌10株(占23.26%)。G^(+)菌对苯唑西林的敏感率为38.10%,G-菌对头孢曲松、头孢他啶、阿米卡星的敏感率分别为62.50%、90.00%、100.00%。抗菌药物治疗方案合理率为66.07%,19例次(33.93%)存在初始治疗或后续治疗抗菌药物品种选择不适宜,其中10例次(17.86%)仅存在初始治疗不合理,2例次(3.57%)仅存在后续治疗不合理,7例次(12.50%)初始治疗和后续治疗均不合理。结论该院PDAP病原菌以G^(+)菌为主,初始治疗建议以万古霉素覆盖G^(+)菌,以头孢他啶或阿米卡星覆盖G-菌,后续治疗应根据药敏试验结果、细菌耐药机制及初始治疗转归等因素,合理选用抗菌药物。Objective To analyze the clinical pathogenic characteristics of peritoneal dialysis-associated peritonitis(PDAP)in a municipal hospital in Changshu,Jiangsu Province,evaluate the rationality of antibiotic selection,and provide basis for clinical rational drug use.Methods Clinical data of 46 PDAP patients admitted in Changshu Hospital Affiliated to Soochow University from 2018 to 2023 were collected and reviewed,including clinical signs,laboratory indicators,pathogenic bacteria distribution,drug sensitivity and anti-infective treatment.Results The 46 patients experienced 56 cases of PDAP,and the clinical manifestations were abdominal pain,cloudy peritoneal fluid and fever.The 43 strains of pathogenic bacteria were isolated and cultured,including 33 strains(76.74%)of Gram positive(G^(+))bacteria,mainly Staphylococcus genus,and 10 strains(23.26%)of Gram negative(G-)bacteria.The sensitivity of G^(+)bacteria to benzylpenicillin was 38.10%,while those of G-bacteria to ceftriaxone,ceftazidime and amikacin were 62.50%,90.00%and 100.00%.The rational rate of antibiotic treatment was 66.07%,and 19 cases(33.93%)had inappropriate selection of antibiotic varieties for initial or subsequent treatment,of which 10 cases(17.86%)only had unreasonable initial treatment,2 cases(3.57%)only had unreasonable subsequent treatment,and 7 cases(12.50%)had unreasonable initial and subsequent treatment.Conclusions The main pathogenic bacteria for PDAP are G^(+)bacteria.The initial treatment recommendation is to cover G^(+)bacteria with vancomycin and G-bacteria with cefotaxime or amikacin.Subsequent treatment should be based on factors such as drug sensitivity,bacterial resistance mechanisms and initial treatment outcomes,and the antibiotics should be rationally selected.

关 键 词：腹膜透析相关腹膜炎 病原菌 抗菌药物 

分 类 号：R446.5[医药卫生—诊断学]