91例次腹膜透析相关性腹膜炎的致病菌耐药性分析及其与预后的关系

Analysis of antibiotic resistance in pathogenic bacteria from 91 episodes of peritoneal dialysis related peritonitis and its correlation to the prognosis of peritonitis

目的 分析单中心腹膜透析相关性腹膜炎的致病菌的耐药情况及其与患者预后的关系.方法 回顾性分析单中心5年间91例次腹膜透析相关性腹膜炎病例资料,总结腹膜炎发生率、致病菌分布、耐药菌株分布情况,分析细菌耐药与预后关系.结果 66例患者共发生腹膜炎91例次,培养阳性71例次,阳性率为78.0％,培养阴性20例次.71例次致病菌中,革兰氏阳性菌占32例次,革兰氏阴性菌31例次,混合菌感染1例次,真菌感染7例次.革兰氏阳性菌中最多为表皮葡萄球菌,革兰氏阴性菌中最多者为大肠埃希菌.革兰氏阳性菌中对苯唑西林及头孢唑啉耐药高达80.8％,但均对万古霉素及替考拉宁敏感.革兰氏阴性菌中对头孢他啶及氨曲南耐药达23.1％～26.9％,对阿米卡星均敏感.退出组对头孢耐药率为66.7％（8/12）,复发组耐药率为50.0 （5/10）,治愈组耐药率为58.1％（25/43）,退出组与治愈组耐药率比较差异无统计学意义（P＞0.05）,复发组与治愈组比较差异也无统计学意义（P＞0.05）.结论 不同致病原导致的腹膜透析相关腹膜炎在耐药性、抗生素选择、疗效及预后等方面具有各自的特点.治疗上应当结合病原学临床特点和药敏,初始治疗方案按照“中心个体化”的主张选择适当的抗生素.细菌对经验性使用的抗生素耐药并非患者反复发生腹膜炎及退出的主要原因.

Objective To investigate the correlation between drug resistance of pathogenic bacteria and prognosis of peritoneal dialysis related peritonitis in a single peritoneal dialysis center.Methods Ninety-one episodes of peritonitis in 61 peritoneal dialysis patients from January 2008 to January 2013 were analyzed.The prevalence of peritonitis,the spectrum of pathogenic bacteria and their resistance to antibiotics,and the relationship between drug resistance of bacteria and prognosis of peritonitis were retrospectively analyzed.Results Seventy-one episodes （78.0％） were pathogenic culture positive,in which gram-positive bacteria were found in 32 episodes,Gram-negative bacteria in 31 episodes,mixed bacteria in one episode,and fungi in 7 episodes.Twenty episodes （22.0％） were pathogenic culture negative.Staphylococcus epidermidis was the most common Gram-positive pathogen,and Escherichia coli was the most common Gram-negative pathogen.Gram-positive bacteria were resistant to Oxacillin and Cefazolin （80.8％） and susceptible to Vancomycin and Teicoplanin.Gram-negative bacteria were resistant to Ceftazidime and Aztreonam （23.1％ to 26.9％） and susceptible to Amikacin.No statistical differences in resistance to cephalosporins were found among dropout patients （8/12,66.7％）,relapsed patients （5/10,50.0％） and cured patients （25/43,58.1％） （P＞0.05）..Conclusion Peritoneal dialysis related peritonitis is variable in its responsible microbes,drug resistance of the microbes,therapeutic effect to antibiotics,and prognosis.In the initial treatment of this peritonitis,individualized antibiotic therapy based on clinical features,pathogens and their susceptibility to antibiotics should be conducted.Peritoneal dialysis patients with recurrent peritonitis and dropout of the treatment may not result from the bacteria resistant to routinely used antibiotics.