腹膜透析相关性腹膜炎致病菌及耐药性分析

Pathogens causing peritoneal dialysis-related peritonitis and their drug resistance

目的探讨持续性非卧床腹膜透析(CAPD)相关性腹膜炎的致病菌及其耐药性。方法回顾性分析49例CAPD腹膜炎患者的病原菌、耐药性和转归。结果 31例培养阳性,透出液培养阳性率为63.27%;共培养菌株34株,其中革兰阳性菌22株,革兰阴性菌9株,真菌3株,最常见的病原菌为表皮葡萄球菌和大肠埃希菌;革兰阳性菌对阿米卡星、利奈唑胺、万古霉素、替考拉宁耐药率最低,分别为0、0、4.76%、5.56%,其次为头孢唑林、左氧氟沙星、哌拉西林/他唑巴坦,分别为35.00%、36.36%、37.50%;革兰阴性菌对阿米卡星、亚胺培南耐药率最低,均为0,其次为哌拉西林/他唑巴坦、头孢哌酮/舒巴坦,均为37.50%,对头孢他啶的耐药率为77.78%。结论腹膜透析相关性腹膜炎致病菌仍以革兰阳性菌为主;腹膜炎患者经验治疗可选用哌拉西林/他唑巴坦单一用药;头孢唑林联合头孢哌酮/舒巴坦;左氧氟沙星联合头孢哌酮/舒巴坦;无残存肾功能者可单独选用阿米卡星。

OBJECTIVE To investigate the pathogens and their resistance in CAPD-related peritonitis.METHODS Pathogens,resistance and outcomes of 49 cases of CAPD-related peritonitis were analyzed retrospectively.RESULTS Totally 31 cases were cultured positive with a positive rate of 63.27%.A total of 34 strains were cultured,including 22 Gram-positive strains,9 Gram-negative strains and 3 fungi strains.The most common pathogens were Staphylococcus epidermidis and Escherichia coli.Gram-positive bacteria showed lowest resistance rate to amikacin（0）,linezolid（0）,vancomycin（4.76%） and teicoplanin（5.56%）,followed by cefazolin（35.00%）,levofloxacin（36.36%）,piperacillin/tazobactam（37.5%）.Gram-negative bacteria showed lowest resistance to amikacin（0）,imipenem（0）,then were piperacillin/tazobactam（37.5%）,cefoperazone/sulbactam（37.50%）,the resistance rate to ceftazidime was 77.78%.CONCLUSION Gram-positive bacteria are the predominant pathogens causing peritoneal dialysis-related peritonitis.Experience in treating patients with peritonitis can choose：piperacillin/tazobactam monotherapy;cefazolin joint cefoperazone/sulbactam;levofloxacin joint cefoperazone/sulbactam;those without residual renal function may use amikacin alone.