持续性非卧床腹膜透析相关性腹膜炎临床分析

发布时间：2018-04-17 07:56

本文选题：腹膜透析相关腹膜炎 + 临床特征　；参考：《中南大学学报(医学版)》2016年12期

【摘要】：目的:探讨某三甲医院持续性非卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)相关性腹膜炎临床特点、致病菌分布及耐药性情况,为临床防治CAPD相关性腹膜炎总结经验。方法:回顾性调查该院2013年1月至2016年6月42个月中,104人126例次CAPD相关性腹膜炎患者的临床特点、致病菌分布、耐药性等情况。结果:在126例次CAPD相关性腹膜炎中,患者出现腹痛104例次(82.54%),发热56例次(44.44%),腹泻49例次(38.89%),呕吐31例次(23.60%)。126例次CAPD相关性腹膜炎中,发生一次腹膜炎的88人次,多次和反复发作的腹膜炎16人38例次,其中复发性腹膜炎2例,腹膜炎重现2例,导管相关性腹膜炎3例。在103例送检的腹水标本中,培养阳性64例次,阳性率达62.14%。共分离出致病菌70株,其中革兰阳性细菌42株,革兰阴性细菌21株,真菌7株。主要的革兰阳性菌包括表皮葡萄球菌、粪肠球菌、溶血葡萄球菌;主要的革兰阴性菌包括大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌;真菌以白假丝酵母菌为主。革兰阳性菌对庆大霉素、左氧氟沙星、莫西沙星、万古霉素、利奈唑胺的耐药率分别为20.00%,36.11%,5.00%,0%,0%;革兰阴性菌对头孢哌酮/舒巴坦、庆大霉素、头孢唑啉、头孢他啶的耐药率分别为6.25%,10.53%,64.29%,15.38%,对亚胺培南、阿米卡星、哌拉西林/他唑巴坦的耐药率均为0%。结论:革兰阳性菌是CAPD相关性腹膜炎的主要致病菌,临床不仅应尽早开始经验性治疗,而且要考虑如何通过改善培养方法以提高阳性检出率;可以根据药敏结果调整用药,以促进患者CAPD相关性腹膜炎的治愈和腹膜功能的恢复。
[Abstract]:Objective: to investigate the clinical characteristics, distribution of pathogenic bacteria and drug resistance of continuous ambulatory peritoneal peritonitis in continuous ambulatory peritoneal dialysis (ambulatory peritoneal dialysissis) in a third class hospital, and to summarize the experience in the prevention and treatment of CAPD associated peritonitis.Methods: the clinical characteristics, distribution of pathogenic bacteria and drug resistance of 126 patients with CAPD associated peritonitis from January 2013 to June 2016 were investigated retrospectively.Results: of the 126 cases of CAPD associated peritonitis, 104 cases had abdominal pain (82.54), 56 cases had fever (44.44g), 49 cases had diarrhea (38.89%), 31 cases had vomiting and 23.600.126 cases had CAPD associated peritonitis, 88 cases had one peritonitis.There were 16 cases of multiple and recurrent peritonitis in 38 cases, including 2 cases of recurrent peritonitis, 2 cases of peritonitis recurrence and 3 cases of ductal peritonitis.Among 103 ascites samples, 64 cases were positive in culture, the positive rate was 62.14%.A total of 70 strains of pathogenic bacteria were isolated, including 42 Gram-positive bacteria, 21 Gram-negative bacteria and 7 fungi.The main gram-positive bacteria include Staphylococcus epidermidis, Enterococcus faecalis, Staphylococcus haemolyticus; the main gram-negative bacteria include Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and the main fungi are Candida albicans.The resistance rates of gram-positive bacteria to gentamicin, levofloxacin, moxifloxacin, vancomycin, and linazolamide were 20.00 and 36.110.The Gram-negative bacteria were resistant to cefoperazone / sulbactam, gentamycin, cefazolin, and cefazolin, respectively.The drug resistance rates of ceftazidime were 6.25 and 64.293.The drug resistance rates to imipenem, amikacin, piperacillin / tazobactam were 0.Conclusion: Gram-positive bacteria are the main pathogenic bacteria of CAPD associated peritonitis. Clinical experience therapy should be started as soon as possible, and how to improve the culture method should be considered to increase the positive rate, the drug can be adjusted according to the results of drug sensitivity.To promote the CAPD-associated peritonitis and the recovery of peritoneal function.
【作者单位】：敦煌市医院感染控制科;中南大学湘雅医院感染控制中心;中南大学湘雅医院肾内科;
【基金】：湖南省自然科学基金(13JJ6013) 中南大学校级大数据基金(2014-33);中南大学湘雅医院院内临床基金(2014-11)~~
【分类号】：R459.5

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