102例次腹膜透析相关性腹膜炎的致病菌谱和耐药性分析

发布时间：2018-05-28 17:02

本文选题：腹膜透析 + 腹膜炎　；参考：《上海医学》2016年03期

【摘要】：目的分析腹膜透析患者发生腹膜透析相关性腹膜炎(PDAP)的致病菌及其耐药性,指导临床合理应用抗菌药物。方法选取2012年1月—2015年6月同济大学附属同济医院肾内科收治的腹膜透析患者资料,其中77例患者并发PDAP,共发生PDAP 102例次,回顾性分析其透析液致病菌培养结果、耐药情况、治疗效果和治疗转归。结果腹膜透析液培养致病菌结果阳性81例次,阴性21例次,细菌培养的阳性率为79.4%,其中革兰阳性菌感染56例次(69.1%),革兰阴性菌感染20例次(24.7%),真菌感染2例次(2.5%),2种以上致病菌感染3例次(3.7%)。56例次革兰阳性菌对青霉素的耐药率最高(78.6%),其次是红霉素(48.2%),苯唑西林(42.9%)位居第三,对万古霉素均敏感;20例次革兰阴性菌对头孢唑啉的耐药率最高(65.0%),对亚胺培南的耐药率最低(10.0%),对阿米卡星和头孢他啶的耐药率分别为25.0%和20.0%;革兰阳性菌中葡萄球菌属最多,葡萄球菌属对苯唑西林的耐药率较高,达45.0%(18/40,均为凝固酶阴性葡萄球菌),对万古霉素均敏感。PDAP的总体治愈率为82.4%(84/102),致病菌为革兰阳性菌腹膜炎的退出率为12.5%(7/56),革兰阴性菌腹膜炎的退出率为30.0%(6/20),真菌性腹膜炎的退出率为2/2,双重感染的退出率为2/3,培养阴性的腹膜炎的退出率为4.8%(1/21)。结论 PDAP的致病菌以革兰阳性菌为主,经验治疗应以中心特异性原则选择合适的抗生素,致病菌的差异是影响其预后的重要因素。
[Abstract]:Objective to analyze the pathogenic bacteria and their drug resistance in peritoneal dialysis patients with peritoneal dialysis associated peritonitis (PDAP) and to guide the rational use of antimicrobial agents. Methods from January 2012 to June 2015, the data of peritoneal dialysis patients in Tongji Hospital affiliated to Tongji University, Tongji University, were selected, 77 of them were complicated with PDAP and 102 times of PDAP. the results of dialysate pathogenic bacteria culture and drug resistance were analyzed retrospectively. Therapeutic effect and outcome. Results 81 positive and 21 negative peritoneal dialysate cultures were positive. The positive rate of bacterial culture was 79.4%, of which 56 cases were Gram-positive bacteria infection, 20 cases were Gram-negative bacteria infection, and 2 cases were fungal infection. The resistance rate of Gram-positive bacteria to penicillin was the highest in 3 cases. 56 cases of Gram-positive bacteria were resistant to penicillin. 78.6%, followed by erythromycin 48.2 and oxacillin 42.9). The resistance rate of 20 gram-negative bacteria to cefazolin was the highest (65.0%), the lowest to imipenem (10.0%), to amikacin and ceftazidime (25.0%) and to ceftazidime (20.0%). The resistance rate of staphylococcus to oxacillin was higher. To 45.0% 18 / 40, all coagulase-negative staphylococci, the overall cure rate for vancomycin sensitive. PDAP is 82.40.84 / 102, for gram-positive peritonitis, 12.5g / 7 / 56, for gram-negative peritonitis, 30.06 / 20, for fungal peritonitis, for gram-negative bacterial peritonitis, for vancomycin, for gram-positive peritonitis, for gram-negative bacterial peritonitis, for coagulase-negative staphylococci. The exit rate was 2 / 2, the exit rate for double infection was 2 / 3, and the exit rate for culture negative peritonitis was 4.8 / 21. Conclusion Gram-positive bacteria are the main pathogens of PDAP. The choice of appropriate antibiotics should be based on the principle of central specificity. The difference of pathogenic bacteria is an important factor affecting the prognosis of PDAP.
【作者单位】：同济大学附属同济医院肾内科;同济大学附属同济医院检验科;
【基金】：国家自然科学基金资助项目(81370790)
【分类号】：R446.5

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