腹膜透析相关腹膜炎的病原菌耐药性分析

Distribution and drug resistance of pathogens isolated from patients with peritoneal dialysis-related peritonitis

目的分析腹膜透析相关腹膜炎的病原菌及其耐药性特点,以期指导临床合理使用抗菌药物。方法回顾性分析2007年1月-2016年12月在复旦大学附属华山医院就诊的腹透相关性腹膜炎病例,统计患者的病原菌分布及其耐药性。结果对203例次腹透相关性腹膜炎患者的送检标本进行细菌培养,检出病原菌160株,其中革兰阳性菌95株占59.4%,革兰阴性菌62株占38.8%,真菌3株占1.8%;革兰阳性菌中凝固酶阴性葡萄球菌对青霉素的耐药率较高,为81.1%,酿脓链球菌的耐药率较低,革兰阴性菌中大肠埃希菌对阿米卡星、环丙沙星耐药率较低,分别为8.3%、25.8%,而对氨苄西林、哌拉西林等耐药率均较高,分别为81.8%、45.2%。结论腹膜透析相关性腹膜炎致病菌以革兰阳性菌为主,推荐万古霉素、利奈唑胺或利福平作为革兰阳性菌腹膜炎的经验用药;革兰阴性菌对庆大霉素、环丙沙星耐药率较低,故可作为首选经验性用药,同时,在培养结果出来后应根据药敏结果及时调整用药。

OBJECTIVE To investigate the distribution and drug resistance of pathogens isolated from patients with peritoneal dialysis-related peritonitis so as to provide guidance for reasonable clinical use of antibiotics.METHODS The patients with peritoneal dialysis-related peritonitis who were treated in Huashan Hospital of Fudan University from Jan 2007 to Dec 2016 were retrospectively analyzed.The distribution and drug resistance of the pathogens isolated from the patients were statistically analyzed.RESULTS The bacterial culture was carried out for submitted specimens that were obtained from 203 case-times of patients with peritoneal dialysis-related peritonitis.A total of 160 strains of pathogens were isolated,of which 59.4%（95 strains）were gram-positive bacteria,38.8%（62 strains）were gram-negative bacteria,and 1.8%（3 strains）were fungi.Among the gram-positive bacteria,the drug resistance rate of coagulase-negative Staphylococcus strains to penicillin was 81.1%,and the drug resistance rate of Streptococcus pyogenes strains was low.Among the gram-negative bacteria,the drug resistance rates of Escherichia coli strains to amikacin and ciprofloxacin were 8.3%and 25.8%,respectively,while the drug resistance rates to ampicillin and piperacillin were 81.8%and 45.2%,respectively.CONCLUSION The gram-positive bacteria are dominant among the pathogens causing the peritoneal dialysis-related peritonitis,and vancomycin,linezolid or rifampicin is recommended for empirical drug therapy fro treatment of peritonitis caused by the gram-positive bacteria.The gram-negative bacteria are highly susceptible to gentamicin and ciprofloxacin,which should be preferred for the empirical drug therapy,and it is necessary to adjust the medication on the basis of the result of drug susceptibility testing after the bacterial culture.