腹膜透析相关腹膜炎的病原菌耐药性分析

发布时间：2018-02-24 14:31

本文关键词： 腹膜透析腹膜炎病原菌耐药性　出处：《中华医院感染学杂志》2017年17期 　论文类型：期刊论文

【摘要】：目的分析腹膜透析相关腹膜炎的病原菌及其耐药性特点,以期指导临床合理使用抗菌药物。方法回顾性分析2007年1月-2016年12月在复旦大学附属华山医院就诊的腹透相关性腹膜炎病例,统计患者的病原菌分布及其耐药性。结果对203例次腹透相关性腹膜炎患者的送检标本进行细菌培养,检出病原菌160株,其中革兰阳性菌95株占59.4%,革兰阴性菌62株占38.8%,真菌3株占1.8%;革兰阳性菌中凝固酶阴性葡萄球菌对青霉素的耐药率较高,为81.1%,酿脓链球菌的耐药率较低,革兰阴性菌中大肠埃希菌对阿米卡星、环丙沙星耐药率较低,分别为8.3%、25.8%,而对氨苄西林、哌拉西林等耐药率均较高,分别为81.8%、45.2%。结论腹膜透析相关性腹膜炎致病菌以革兰阳性菌为主,推荐万古霉素、利奈唑胺或利福平作为革兰阳性菌腹膜炎的经验用药;革兰阴性菌对庆大霉素、环丙沙星耐药率较低,故可作为首选经验性用药,同时,在培养结果出来后应根据药敏结果及时调整用药。
[Abstract]:Objective to analyze the pathogenic bacteria and drug resistance of peritoneal dialysis associated peritonitis. Methods from January 2007 to December 2016, the patients with peritoneal dialysis associated peritonitis treated in Huashan Hospital, Fudan University, were retrospectively analyzed. Results bacterial culture was carried out in 203 specimens of patients with peritoneal dialysis associated peritonitis and 160 strains of pathogens were detected. Among them, 95 strains of Gram-positive bacteria accounted for 59.4%, 62 strains of Gram-negative bacteria accounted for 38.8%, 3 strains of fungi accounted for 1.8%, the rate of resistance to penicillin of coagulase-negative Staphylococcus in Gram-positive bacteria was higher (81.1%), and the resistance rate of Streptococcus pyogenes was lower. The resistance rates of Escherichia coli to amikacin and ciprofloxacin were lower than those of ampicillin, ciprofloxacin and ampicillin, respectively, and the resistance rates of Escherichia coli to ampicillin and piperacillin were higher than those of ampicillin and piperacillin. Conclusions Gram-positive bacteria are the main pathogenic bacteria of peritoneal dialysis related peritonitis. Vancomycin, linazolamine or rifampicin are recommended as empirical drugs for gram-positive peritonitis. Ciprofloxacin resistance rate is relatively low, so it can be used as the first choice of empirical medicine, at the same time, the drug should be adjusted according to the results of drug sensitivity.
【作者单位】：复旦大学附属华山医院护理部;
【分类号】：R459.5;R572.2

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