腹膜透析相关性腹膜炎患者感染病原菌特点分析

发布时间：2018-08-03 11:09

【摘要】：目的分析腹膜透析相关性腹膜炎患者感染革兰阳性菌与革兰阴性菌的特点。方法选择医院2006年1月-2016年12月腹膜透析相关性腹膜炎革兰阳性菌感染患者32例作为革兰阳性菌组,腹膜透析相关性腹膜炎革兰阴性菌感染患者56例作为革兰阴性菌组,回顾性分析患者的发热、腹透液性状、腹痛等临床资料及实验室检查结果、病原菌培养和药敏结果。结果革兰阳性菌组和革兰阴性菌组患者发热、腹透液性状、腹痛比较差异无统计学意义;革兰阳性菌组中性粒细胞数、C-反应蛋白、透析液有核细胞数、透析液中性粒细胞比例均低于革兰阴性菌组(P0.05),革兰阳性菌组血清钾高于革兰阴性菌组(P0.05),两组血清尿素氮、血肌酐、血清钠、血清氯、血清钙、血清磷指标比较差异无统计学意义;革兰阳性菌组感染病原菌以表皮葡萄球菌、金黄色葡萄球菌为主,分别占46.9%、18.8%,革兰阴性菌组感染病原菌以大肠埃希菌、肺炎克雷伯菌为主,分别占39.3%、19.6%;表皮葡萄球菌和金黄色葡萄球菌对苯唑西林和红霉素耐药率较高,耐药率分别为73.3%、80.0%,83.3%、66.7%,对利奈唑胺、万古霉素、替考拉宁的耐药率均为0;大肠埃希菌和肺炎克雷伯菌对氨苄西林的耐药率较高,耐药率分别为77.3%、72.7%,对阿米卡星、亚胺培南、头孢哌酮/舒巴坦的耐药率均为0。结论腹膜透析相关性腹膜炎革兰阳性菌感染患者C-反应蛋白和中性粒细胞水平较低,血清钾水平较高,主要以表皮葡萄球菌、金黄色葡萄球菌感染为主,对红霉素、苯唑西林耐药性高,腹膜透析相关性腹膜炎革兰阴性菌感染以大肠埃希菌和肺炎克雷伯菌为主,对氨苄西林耐药性较高。
[Abstract]:Objective to analyze the characteristics of Gram-positive and Gram-negative bacteria infection in patients with peritoneal dialysis associated peritonitis. Methods from January 2006 to December 2016, 32 patients with Gram-positive bacteria infection associated with peritoneal dialysis associated with peritonitis were selected as Gram-positive bacteria group and 56 patients with Gram-negative bacteria infection associated with peritoneal dialysis associated peritonitis as Gram-negative bacteria group. The clinical data, laboratory results, pathogen culture and drug sensitivity of patients with fever, peritoneal dialysis, abdominal pain and so on were analyzed retrospectively. Results there was no significant difference in the characteristics of fever, peritoneal dialysis and abdominal pain between Gram-positive bacteria group and Gram-negative bacteria group, but the number of neutrophils in Gram-positive bacteria group and the number of nucleated cells in dialysate were not significantly different. The percentage of neutrophils in dialysate was lower than that in Gram-negative bacteria group (P0.05), serum potassium in Gram-positive bacteria group was higher than that in Gram-negative bacteria group (P0.05), serum urea nitrogen, serum creatinine, serum sodium, serum chlorine, serum calcium in both groups were higher than those in Gram-positive bacteria group (P0.05). In Gram-positive bacteria group, Staphylococcus epidermidis and Staphylococcus aureus accounted for 46.9% and 18.8%, respectively. In Gram-negative group, Escherichia coli and Klebsiella pneumoniae were the main pathogens. The resistance rates of Staphylococcus epidermidis and Staphylococcus aureus to oxacillin and erythromycin were 73.3% and 83.3%, respectively. The resistant rates of teicoplanin and Klebsiella pneumoniae to ampicillin were higher than those of Escherichia coli and Klebsiella pneumoniae, 77.33and 72.7, respectively, and to amikacin, imipenem and cefoperazone / sulbactam. Conclusion the levels of C-reactive protein and neutrophils in patients with peritoneal dialysis associated peritonitis Gram-positive bacteria infection were lower and the serum potassium levels were higher. Staphylococcus epidermidis and Staphylococcus aureus were the main infections. The drug resistance of oxacillin was high, the infection of gram-negative bacteria in peritoneal dialysis associated peritonitis was mainly Escherichia coli and Klebsiella pneumoniae, and the resistance to ampicillin was higher.
【作者单位】：宁波市奉化区人民医院肾内科;宁波市医疗中心李惠利医院肾内科;
【基金】：浙江省医药卫生一般研究计划(2015KYA025)
【分类号】：R459.5;R572.2

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