持续性非卧床腹膜透析腹膜炎的致病菌及其耐药性

Pathogens and their resistance in CAPD-related peritonitis

目的 探讨持续性非卧床腹膜透析（ＣＡＰＤ）腹膜炎的致病菌及其耐药性。方法 回顾性分析１０９例ＣＡＰＤ腹膜炎的临床表现、致病菌、耐药性和转归情况。结果４３例培养阳性，透出液培养阳性率为 ３９．４％，其中１１例为革兰阳性球菌，１９例为革兰阴性杆菌，１３例为真菌。主要的革兰阴性杆菌包括肺炎克雷白氏杆菌、大肠杆菌、不动杆菌和铜绿假单胞菌。革兰阴性杆菌对氨苄西林的耐药率最高，达８５．７％；对阿米卡星的耐药率最低，为１７．６％；庆大霉素的耐药享为４４．４％：而头孢他啶的耐药率也高达４２．９％。所有革兰阳性球菌对万古霉素敏感，大部分 （７１．４％）对头孢唑林敏感。腹腔内用抗真菌药对真菌性腹膜炎疗效不佳。腹膜炎ＣＡＰＤ的退出率为２０．２％（２２／１０９）。结论 革兰阴性杆菌腹膜炎比例有所增加，致病菌对庆大霉素和头抱他啶的耐药性较高，而对阿米卡星较敏感，宜作为经验用药。

Objective To investigate the pathogens and their resistance in CAPD-related peritonitis. Methods Clinical manifestation, pathogens, resistance and outcomes of 109 cases of CAPD-related peritonitis were analyzed retrospectively. Results 43 cases were culture positive with a positive rate of 39. 4% . including 11 cases of gram-positive cocci, 19 cases of gram-negative bacilli and 13 cases of fungi. Klebsiella Pneumoniae, Escherichia Coli, Anectobacter and Pseudomonas aeruginosa were the most common causes of gram-negative bacilli, which showed high resistant rate of 85. 7% to ampicillin and low resistant rate of 17. 6% to amikacin. 44. 4% of bacilli were resistant to gentamycin and 42. 9% were resistant to ceftazidine. 71.4% of the gram-positive cocci were sensitive to cefazolin and all were sensitive to vancomycin. Intraperitoneal administration of anti-fungi agents was ineffective for fungal peritonitis. The total CAPD withdrawal rate in peritonitis was 20. 2% (22/109). Conclusions There is increasing proportion of peritonitis caused by gram-negative bacilli, which show increased resistance to gentamycin or ceftazidine and are generally sensitive to amikacin. Therefore, amikacin is recommended for empiric therapy for CAPD-related peritonitis.