培养阴性腹膜透析相关性腹膜炎的治疗体会

目的探讨腹膜透析相关性腹膜炎培养阴性的影响因素及治疗方案。方法回顾性分析62例共98例次腹膜透析相关性腹膜炎患者,对比分析培养阴性及阳性腹膜透析相关性腹膜炎的近期抗生素使用情况、临床特点及治疗效果。结果 62例共98例次腹膜透析相关性腹膜炎患者,培养阳性者73例次(74.4%),培养阴性者25例次(25 5%)。与培养阳性者相比,培养阴性者具有更高的近期抗生素使用史(28%vs 10%,P<0.05),两者在治愈率(84%vs 79.4%)、拔管率(8%vs 8.2%)及复发率(8%vs 12.3%)方面,差异无统计学意义(P>0 05);培养阴性腹膜透析相关性腹膜炎应用万古霉素组治愈率最高(1 00%),应用环丙沙星组治愈率最低(66.6%)。结论近期抗生素使用史是导致腹膜透析相关性腹膜炎腹透液培养阴性的主要原因之一,培养阴性患者可能以革兰氏阳性菌感染为主,治疗上以万古霉素效果最理想。

Objective To explore the influencing factors and treatment of culture-negative peritonitis in peritoneal dialysis patients. Methods 98 cases of peritonitis in peritoneal dialysis patients of 62 individuals were retrospectively contrasted. The culture-negative cases were compared with culture-positive cases in history of previous antibiotic used, clinical characteristics and treatment effect. Results Among 98 cases of peritonitis in peritoneal dialysis patients in 62 individuals,73 cases （ 74.4% ） were cultured positive and 25 cases （ 25.5 % ） were cultured negative. The rate of previous antibiotic used in culture-negative cases was higher than culture-positive ones （28% vs. 10%, P〈0.05 ）. And the rate of cure （84% vs. 79.4% ）,catheter removal（8% vs. 8.2%）, relapse （8% vs. 12.3%）were similar between culture-negative and culture-positive cases. The culture-negative peritonitis in peritoneal dialysis patients were susceptible （100%） to vancomycin, but the cure-rate of ciprofloxacin was lowest（66.6%）. Conclusion The history of previous antibiotic used is one of the main reasons of culture-negative peritonitis in peritoneal dialysis patients. The culture-negative patients are mainly infected by gram-positive bacterial, and vancomycin is the best choice in treatment.