腹膜透析相关性腹膜炎的细菌谱及耐药性分析

Pathogenic bacteria and drug resistance in peritoneal dialysis related peritonitis

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:回顾性分析中南大学湘雅医院肾内科腹膜透析中心2007年1月至2011年1月收治的78例次CAPD相关性腹膜炎患者的致病菌、耐药性及转归。结果:在78例次CAPD腹膜炎患者中,病原菌培养阳性共有52例次,阳性率为66.67%。共培养病原菌55株,其中3例患者为混合感染,培养出2种致病菌。其中革兰阳性菌32株,占58.18%;革兰阴性菌18株,占32.72%;真菌5株,占9.09%。最常见的病原菌为凝固酶阴性葡萄球菌、金黄色葡萄球菌和大肠埃希菌;革兰阳性菌耐药率最低的分别为利奈唑胺(0)、替考拉宁(3.13%)、万古霉素(4%);革兰阴性菌对阿米卡星、亚胺培南耐药率最低,其次为哌拉西林/他唑巴坦、头孢哌酮/舒巴坦,对头孢唑林的耐药率为83.33%。78例次患者共有4例死亡,其中2例为真菌感染,1例革兰阴性菌感染,1例混合感染(死亡率5.13%);11例拔管改行血液透析,其中3例为真菌感染(总拔管率14.1%);其余患者均治愈(治愈率80.77%)。结论:革兰阳性菌仍是腹膜透析相关性腹膜炎的主要致病菌;腹膜炎的治疗应根据细菌培养、药敏,选择敏感有效的抗生素,腹膜炎经验治疗可选用头孢唑林联合氨基糖甙类药物;头孢唑林联合头孢哌酮/舒巴坦或哌拉西林/他唑巴坦。真菌性腹膜炎治疗效果较差,应尽早拔管。

Objective： To investigate the pathogens and their resistance in continuous ambulatory peritoneal dialysis（CAPD） related peritonitis.Methods： A total of 78 cases with CAPD related peritonitis from Xiangya Hospital between January 2007 and January 2011 were reviewed.Pathogens,resistance and outcomes of the 78 cases CAPD related peritonitis were analyzed retrospectively.Results： Among them,53 cases cultured positive（66.67%）,3 of which were combined infection and 2 strains were cultured.A total of 55 strains were cultured,including 32 gram-positive strains（58.18%）,18 gram-negative strains（32.72%） and 5 fungi（9.09%）.The most common pathogens were coagulase negative staphylococcus,staphylococcus aureus and Escherichia coli.Drug sensitivity test of the gram-positive strains showed that the three with lowest antibiotic resistance were linezolid（0）,teicoplanin（3.13%） and vancomycin（4.0%）.Drug sensitivity test of the gram-negative bacteria showed that antibiotics with the lowest resistance were amikacin and imipenem,followed by piperacillin/tazobactam and cepoperazon/sulbactam.Cephazolin had the highest resistance rate of 83.33%.Clinical outcomes： 63 cases cured（80.77%）;11 cases transferred to hemodialysis（14.1%）;4 cases died（5.13%）,including 2 cases fungus infections,1 gram-negative bacteria infection and 1 combined infection.Conclusion： The most common pathogens causing peritoneal dialysis associated peritonitis is gram positive bacteria.In the empirical treatment,in addition to traditional treatment of Cefazolin combined with aminoglycosides,cefazolin combined with piperacillin/tazobactam or cepoperazon/sulbactam is preferable for CAPD associated peritonitis.