腹膜透析液微生物培养病原学分析

Bacteria Distribution and Drug Resistance Analysis of Peritoneal Dialysis Fluid

目的：回顾性分析腹膜透析液标本病原菌种类与药敏试验结果，了解腹膜透析相关感染病原菌的分布与耐药性。方法收集分析西安交通大学医学院第一附属医院2012年11月～2016年3月肾内科住院及门诊患者腹透液标本中分离培养阳性结果的病原菌种类与药敏试验结果。所有菌株均采用全自动微生物分析仪进行鉴定，并检测其对抗生素的敏感性。用 WHONET5.6软件进行数据统计分析。结果研究中共包含菌株309株，其中非重复分离菌株206株。革兰阳性细菌174株（84.47％），革兰阴性细菌28株（13.59％），真菌4株（1.94％）。革兰阳性细菌主要为葡萄球菌属、肠球菌属与链球菌属细菌，其中表皮葡萄球菌最为常见。革兰阴性细菌中大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌最为常见。真菌均为念珠菌。分离菌株中革兰阳性细菌与革兰阴性杆菌均有不同程度的耐药现象，葡萄球菌仅对利奈唑胺与万古霉素敏感率为100％，大肠埃希菌仅对美罗培南、亚胺培南、哌拉西林-他唑巴坦敏感率为100％。结论腹膜透析相关感染以革兰阳性细菌为主，表皮葡萄球菌为最常见的分离菌株。多重耐药现象存在广泛，提示临床合理应用抗生素至关重要。

Objective To investigate bacteria distribution and resistance of peritoneal dialysis fluid through the retrospective analysis of peritoneal dialysis fluid culture results.Methods Data were collected from November 2012 to March 2016 in the First Affiliated Hospital of Xi’an Jiaotong University.The isolated pathogens from peritoneal dialysis fluid specimens of clinical patients were tested by automatic microbial analyzer,and the susceptibility of antibiotics was verified by instrument method and disk diffusion method.WHONET5.6 software was used in data analysis.Results The study included 309 strains including 206 non-repeating ones.In wihch 174 （84.47%）strains of gram-positive bacteria,28 （13.59%）strains of gram negative bacteria,and 4 （1.94%）strains of fungi were enrolled.Most of gram-positive bacteria were Staphylococcus, Enterococcus and Streptococcus,especially Staphylococcusepidermis.Escherichiacoli,Pseudomonasaeruginosa,and Acine-tobacter baumannii were most common in gram-negative bacteria.Fungi areall of Canidia.Bacteria had different levels of drug resistance.All strains of Staphylococcus were all sensitive to Linezolid and Vancomycin,and all strains of Escherichia coli were all sensitive to Meropenem,Imipenem and Piperacillin/Tazobactam.Conclusion The peritoneal related infection was caused most by gram-positive bacteria,and the most common isolates was Staphylococcusepidermis.The existence of multi-ple drug resistance indicated rational usage of antibiotics for anti-infection treatment play vital roles in clinical practice.