腹膜透析相关性腹膜炎的菌谱及其药敏分析

Bacterial spectrum and antimicrobial sensitivity in CAPD-related peritonitis

目的通过分析腹膜透析相关性腹膜炎患者的资料,总结感染病菌的菌谱和药敏特点,以指导临床治疗。方法收集中山大学附属第五医院腹膜透析中心50例持续性不卧床腹膜透析患者共79例次腹膜炎资料,分析菌谱并采用统计软件比较各种抗生素的耐药率之间是否存在差异。结果在79例次腹膜炎中,G+菌感染共35例(44.3%),G-菌感染17例(21.5%),真菌及结核菌各1例(各1.3%),总体培养阳性率为68.4%。对于葡萄球菌属,青霉素、氨苄西林的耐药率高达90%以上,对万古霉素、头孢拉定均敏感。对于链球菌属,左氧氟沙星、万古霉素的耐药率最低。并发现G-菌对阿米卡星、亚胺培南/西司他丁最敏感。结论除经典方案头孢唑林加头孢他定外,头孢拉定联合阿米卡星可以作为腹膜透析相关性腹膜炎的首选治疗方案。

Objective To find out the antimicrobial sensitivity characteristics of bacteria from CAPD-related peritonitis patients in an attempt to optimize the clinical therapy.Methods We collected 79 episodes of peritonitis from 50 patients between January 2006 and August 2010.We then analyzed the changes of bacterial spectrum and the differences of bacterial resistance to antibiotics.SPSS 13.0 software was used for the analyses.Results In the 79 peritonitis episodes,gram-positive organism infection was found in 34 episodes（44.3%）,gram-negative organism infection in 17 episodes（21.5%）,fungus infection in one episode（1.3%）,mycobacterium tuberculosis infection in one episode（1.3%）,and bacterial culture was negative in 25 episodes（31.6%）,with the positive culture rate of 68.4%.In staphylococcus strains,the percentage of resistance to Penicillin and Ampicillin was 90%,that of resistance to Cefazolin was 30.0%,and that of resistance to Cephradine was 0.Methicillin-resistant staphylococcus aureus（MRSA） was not found in this study.In streptococcus strains,the percentage of resistance to Streptomycin,Levofloxacin and Vancomycin was low.In gram-negative organisms,most of them were sensitive to Amikacin and Imipenem/Cilastatin,but the percentage of resistance to Ceftazidime was 17.6%.Conclusion In addition to the traditional antibiotics of Cefazolin and Ceftazidime,Cephradine combined with Amikacin are preferable for the treatment of CAPD-related peritonitis.