腹膜透析相关性腹膜炎致病菌及其耐药性分析

Analysis of the Pathogenic Bacteria of Peritoneal Dialysis Related Peritonitis and Their Drug Resistance

目的：探讨腹膜透析相关性腹膜炎的致病菌及细菌耐药情况，指导临床用药。方法回顾性分析该腹膜透析中心2009年12月-2013年8月共70例腹膜炎患者的腹膜透析流出液培养＋药敏结果。其中男性50例，女性20例，年龄21～77岁，平均（46.8±26.3）岁。结果其中复发3例，再发1例，药敏培养阳性23例，阳性率为38.3%，其中革兰氏阳性菌占10例（43.5%），革兰氏阴性菌12例（52.2%），真菌1例（4.3%）；革兰阳性球菌对万古霉素均敏感，对青霉素耐药率较高（80%），苯唑西林耐药率83.3%，红霉素耐药率100%；革兰阴性菌对美洛培南、亚胺培南、丁胺卡那霉素、哌拉西林他唑巴坦均敏感，头孢他啶敏感率较高（90%），氨苄西林均耐药。结论革兰氏阳性菌和阴性菌所占比例相当，对氨苄西林均耐药。革兰氏阳性球菌对万古霉素敏感，革兰氏阴性菌对美洛培南、亚胺培南、丁胺卡那霉素、哌拉西林他唑巴坦敏感。

Objective To explore the pathogenic bacteria of peritoneal dialysis related peritonitis and their drug resistance so as to guide the clinical medication. Methods The culture and result of drug susceptibility test of 70 cases of peritoneal dialysis effluent in our peritoneal dialysis center from December, 2009 to August, 2013 were analyzed retrospectively. Of the patients, there were 50 males, 20 females, aged from 21 to 77, the average age was 46.8±26.3. Results Among them, reoccurrence occurred in 3 cases, relapse occurred in 1 case, 23 cases of positive drug susceptibility, the positive rate was 38.3%; including 10 cases of gram-posi-tive bacteria （43.5%）, 12 cases of gram-negative bacteria （52.2%）, 1 case of fungus （4.3%）;gram-positive bacteria were sensitive to vancomycin, the drug resistance rate of penicillin was as high as 80%, the resistance rate of oxacillin was 83.3%, that of ery-thromycin was 100%;gram-negative bacteria were sensitive to meropenem, imipenem, amikacin, piperacillin sodium and tazobac-tam sodium, the sensitive rate of ceftazidime was higher （90%）, but were resistant to ampicillin. Conclusion The proportion of gram-positive bacteria and gram-negative bacteria is almost the same, both of them are resistant to ampicillin. Gram-positive bac-teria are sensitive to vancomycin, and gram-negative bacteria are sensitive to meropenem, imipenem, amikacin, piperacillin sodium and tazobactam sodium.