34例腹膜透析相关性腹膜炎致病菌种类及耐药性分析与研究

Analysis and Research of Type and Tolerance of 34 Cases with Peritoneal Dialysis-related Peritonitis Pathogenic Bacteria

目的分析腹膜透析患者形成并发症腹膜炎的感染病原菌类型与不同病原菌对临床常用药的耐药状况。方法随机抽取在2013年6月—2016年5月在医院接受治疗的腹透相关性腹膜炎患者共有34例,取全部患者的腹透液分别进行细菌培养与药敏试验,分析总结其感染病原菌的类型与耐药状况。结果发病次数42例,共有31例呈现出阳性,比例是73.81%。在病原菌中共有21株属于有革兰氏阳性菌,比例是67.74%,其中表皮葡萄球菌的比例最高(25.80%,8例),共有8株属于革兰氏阴性菌,比例是25.80%,其中铜绿假单胞菌的比例最高(9.68%,3例),共有2株属于真菌,比例是6.45%。在耐药程度方面,革兰氏阳性菌在应用药物替加环素、利福平、利奈唑胺以及万古霉素时耐药程度较小。在应用药物青霉素(63.16%)、氯洁霉素(80.00%)与红霉素(60.00%)时耐药程度较高;而革兰氏阴性菌在应用药物亚胺培南(0.00%)、美洛培南(0.00%)、哌拉西林/他唑巴坦(0.00%)与厄他培南(0.00%)时耐药程度较小,在应用药物头孢唑林(75.00%)、氨苄西林(100.00%)、头孢呋辛酯(100.00%)时耐药程度较高。结论在腹透相关性腹膜炎患者感染的病原菌中大部分属于革兰氏阳性菌,而其中葡萄球菌的比例最高。传统用药治疗的效果不佳,病原菌对该类药物存在较高的耐用性,因此在治疗中可考虑应用亚胺培南、万古霉素以及哌拉西林/他唑巴坦等药物。

Objective To analyze the type and tolerance of 34 cases with peritoneal dialysis-related peritonitis pathogenic bacteria. Methods 34 cases of patients with peritoneal dialysis-related peritonitis admitted and treated in our hospital from June 2013 to May 2016 were randomly selected and the peritoneal dialysis solutions of all patients were for bacterial culture and drug sensitivity test, and the type and tolerance of infection pathogenic bacteria were summarized and analyzed. Results The incidence number was 42, including 31 positive cases, accounting for 73. 81%, and there were 21 cases of gram-positive bacteria, accounting for 67.74%, and the ratio of staphylococcus epidermidis was the highest（9.68%,3 cases）and 2strains of funguses, accounting for 6.45%, and the drug tolerance of tegafur, rifampin, linezolid, and vancomycin was high,and the drug tolerance of penicillin, clindamycin and erythromycin was high, which was respectively 63.16%, 80.00% and60.00%, and the drug tolerance of imipenem, meropenem, piperacillin/tazobactam and ertapenem was respectively（0.00%）,（0.00%）,（0.00%） and（0.00%）, The proportion of epidermal staphylococws aures was highest（25.80%,8 canses）, 8 of which belonged to gram-negative bacteria,and the proportion was 25.80% and the drug tolerance of cefazolin, ampicillin and cefuroxime axetil was high, which was respectively（75.00%）,（100.00%）and（100.00%）. Conclusion The most of the peritoneal dialysis-related peritonitis pathogenic bacteria are the gram-positive bacteria, and the ratio of staphylococcus is the highest, and the treatment effect of traditional medication is not good, and the drug tolerance of pathogenic bacteria to this drug is high, therefore, we should consider the imipenem, vancomycin, and piperacillin/tazobactam in treatment.