腹膜透析相关性腹膜炎患者病原菌耐药性及预后分析

Pathogenic bacteria,antibiotic resistance and prognosis of peritonitis in peritoneal dialysis patients

目的了解腹膜透析(PD)患者腹膜炎的病原学特点、耐药情况及预后。方法回顾性分析2009年1月至2016年9月四川省人民医院PD中心发生的318例次PD相关性腹膜炎,对病原学种类、耐药性情况及腹膜炎结局进行分析。结果(1)腹膜炎细菌的分布情况:腹透液培养阳性185例次,培养阳性率58.1%。共培养得细菌194株,其中革兰阳性菌131株(67.5%),革兰阳性杆菌49株(25.2%),真菌14株(7.2%)。革兰阳性菌以表皮葡萄球菌和金黄色葡萄球菌为主,分别占25.9%和10.6%。革兰阴性菌以大肠杆菌为主(占40.8%)。(2)腹膜炎致病菌的耐药性分析:革兰阳性菌对青霉素的耐药率较高。革兰阴性菌对氨苄西林的耐药率较高,对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦耐药率较低。真菌呈现出较低耐药性。(3)腹膜炎结局分析:共治愈腹膜炎267例次(83.9%),退出51例次,退出率16.0%,其中拔管转血液透析31例次(9.7%),死亡13例(4.0%),失访7例。(4)腹膜炎复发、再发和重现致病菌分析:腹膜炎复发感染有3例次(0.94%),其中2例次为路邓葡萄球菌感染,1例次为表皮葡萄球菌感染。再发感染有1例次(0.31%)。重现感染有2例次(0.62%)。结论本PD中心导致PD相关性腹膜炎的主要致病菌为革兰阳性菌。革兰阳性和革兰阳性菌都对非加酶抗生素具有较高耐药性,合理选择抗菌药物是治愈PD相关性腹膜炎的关键。

Objective To investigate the pathogenic bacteria,antibiotic resistance and prognosis of peritonitis in peritoneal dialysis（PD）patients.Methods 318 patients with peritonitis from January2009 to September 2016 were enrolled in this study.Pathogenic bacteria culture and drug sensitivity test of PD fluids were performance.The distribution of pathogenic bacteria and their resistance to antibiotics,and clinical outcomes of peritonitis were analyzed.Results（1）Distribution of pathogenic bacteria：185 cases were positively cultured in PD fluids（58.1%）,resulting in a total of 194 strains of microorganisms,including 131 Gram-positive strains（67.5%）,49 Gram-negative strains（25.2%）and 14 fungi strains（7.2%）.Among Gram-positive strains,staphylococcus epidermidis and staphylococcus aureus were common pathogens,accounting for 25.9% and 10.6% respectively.Among Gram-negative strains,colibacillus was major pathogens,accounting for 40.8%.（2）The resistance to antibiotics of pathogenic bacteria：Drug sensitivity test showed Gram-positive strains had highest resistance against penicillin.Gram-negative strains had the highest resistance against ampicillin but the lowest resistance against piperacillin-tazobactam and cefoperazone-sulbactam.Fungi were sensitive to normal antifungal agents.（3）Prognosis of peritonitis：267 cases/times were cured（83.9%）,51 cases dropped out of PD（16.0%）,31 cases were subjected to the removal of catheter and transferred to hemodialysis（9.7%）,13 cases were died（4.0%）,and 7 cases lost to follow-up.（4）Analysis of pathogenic bacteria for relapsing,recurrence and repeat peritonitis：There were 2 cases of staphylococcus lugdunensis infection,1 case of staphylococcus epidermidis infection among 3 cases of relapsing peritonitis（0.94%）.Moreover,1 case of recurrence peritonitis（0.31%）and 2 cases of repeat peritonitis（0.62%）were observed.Conclusions Gram-positive bacteria are major pathogenic bacteria in peritonitis patients in our center.Both Gram-positive and Gram-negative bacteria are high resistant to non-enzyme antibiotics.Sensitive antimicrobial therapy is the key to successfully treat peritonitis.