腹膜透析相关性腹膜炎病原菌及其危险因素

发布时间：2018-04-01 18:13

本文选题：腹膜透析　切入点：腹膜炎　出处：《中国感染控制杂志》2016年10期

【摘要】：目的了解腹膜透析(PD)相关性腹膜炎的细菌谱和耐药情况,为合理使用抗菌药物提供依据。方法回顾性分析某医院2013年1月—2014年12月收治的120例次PD相关性腹膜炎患者的临床资料。结果细菌培养阳性91例次,阳性率为75.83%。共培养病原菌93株,其中革兰阳性(G~+)菌73株(78.49%),革兰阴性(G~-)菌13株(13.98%),最常见的菌种G~+菌是表皮葡萄球菌(38株,40.86%)和G~-菌为大肠埃希菌(3株,3.23%)。G~+菌对青霉素(93.65%)、红霉素(69.57%)和苯唑西林(64.41%)有较高的耐药率,对万古霉素(2.90%)和利奈唑胺(1.47%)耐药率较低,对替考拉宁、替加环素和呋喃妥因均敏感。G~-菌对头孢唑林(50.00%)、头孢呋辛(37.50%)和氨苄西林(37.50%)有较高的耐药率,对亚胺培南、妥布霉素、哌拉西林均敏感。G~+、G~-菌对庆大霉素和左氧氟沙星均具有较低的耐药率。换液操作不规范(56.67%)是引起腹膜炎最常见的原因,主要为G~+菌感染(79.41%);而腹泻引起的腹膜炎主要为G~-菌感染(52.63%)。G~+菌、G~-菌和细菌培养阴性腹膜炎的治愈率分别为92.96%、76.92%和86.21%,三者治愈率比较差异无统计学意义(χ~2=3.39,P=0.18)。结论 PD相关性腹膜炎的病原菌以G~+菌为主,多由于换液操作不规范使病原菌经腹透管感染。第一代头孢菌素不能作为对G~+菌的经验性用药,而万古霉素仍是最佳选择。第三代头孢菌素和氨基糖苷类可作为对G~-菌的经验性用药。特殊情况下庆大霉素和左氧氟沙星可单独作为经验性用药。
[Abstract]:Objective to investigate the bacterial spectrum and drug resistance of peritoneal dialysis (PD) associated peritonitis. Methods the clinical data of 120 cases of PD-associated peritonitis admitted in a hospital from January 2013 to December 2014 were analyzed retrospectively. The positive rate was 75.83.93 strains of pathogenic bacteria were cultured. Among them, 73 strains of Gram-positive strain G~ (~) and 13 strains of Gram-negative strain (Gn-) were found to have higher drug resistance to penicillin (93.6565), erythromycin (69.57) and oxacillin (64.41). The most common strain was Staphylococcus epidermidis (Staphylococcus epidermidis, 38 strains, 40.86) and three strains of Escherichia coli (Escherichia coli, E. coli. G~ ~) were found to be resistant to penicillin 93.656.65%, Erythromycin 69.57%) and oxacillin 64.41 (P < 0.05). To vancomycin 2.90) and linazolamine 1.47)), to teicoplanin, tegacycline and furantoin, to cefazolin 50.00cm, cefuroxime 37.50) and ampicillin 37.50)), to imipenem, tobramycin, tobramycin, and to imipenem, tobramycin, and tobramycin. Piperacillin is sensitive to both Glutamycin and levofloxacin. The most common cause of peritonitis is the nonstandard operation of piperacillin and levofloxacin. 79.41% of peritonitis caused by diarrhea were mainly caused by gastroenteritis, and the cure rates of Gnynebacterium and culture negative peritonitis were 92.96% and 86.21%, respectively. There was no significant difference among the three groups (蠂 ~ 23.39P ~ + 0.18). The main pathogens of peritonitis were G- bacteria. The first generation cephalosporin can not be used as an empirical drug for G- bacteria. Vancomycin is still the best choice. The third generation cephalosporins and aminoglycosides can be used as experiential drugs against Gauricobacterium, and gentamicin and levofloxacin can be used as empirical drugs alone under special circumstances.
【作者单位】：宝鸡市人民医院;西安交通大学第一附属医院;
【分类号】：R459.5

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