单中心腹膜透析相关性腹膜炎致病菌谱与药敏分析

Analysis of Microbial Spectrum and Drug Sensitivity in the Patients of Peritoneal Dialysis-Associated Peritonitis

目的:分析腹膜透析相关性腹膜炎(PDAP)致病菌谱及其药敏特点,以指导抗菌药物的合理使用。方法:回顾性分析本院于2014年01月~2016年09月收治的PDAP病例42例次,统计分析临床资料、实验室检查、透出液致病菌分布与药敏、治疗转归情况。结果:透出液致病菌培养阳性率78.57%,其中G+球菌占69.70%、G+杆菌占3.03%、G-杆菌占27.27%。G+球菌对万古霉素、利奈唑烷及替加环素敏感,未发现耐药菌株;G+球菌对青霉素(86.96%)、苯唑西林(57.14%)、红霉素(50.00%)、克林霉素(47.83%)、复方新诺明(47.62%)、环丙沙星(31.82%)耐药率高。G-杆菌对替加环素、厄他培南与亚胺培南敏感,未发现耐药菌株;对丁胺卡那霉素和哌拉西林/他唑巴坦耐药率皆为11.11%;对氨苄西林、头孢唑林、头孢噻肟、头孢曲松、头孢西丁、复方新诺明和庆大霉素耐药率高,分别为85.71%、77.78%、66.67%、62.50%、50.00%、44.44%和33.33%。PDAP总治愈率为85.71%,透出液培养阴性组退出率最高达22.22%,其次是G-杆菌组为11.11%,G+球菌组最低为8.70%。结论:本中心PDAP的致病菌以G+球菌为主,推荐万古霉素联合丁胺卡那霉素作为本中心经验性治疗,治愈率达93.3%。

Objective：To investigate the microbial spectrum and drug sensitivity in the patients of peritoneal dialysis-associated peritonitis（ PDAP） and guide the clinical rational use of antimicrobial agents. Methods：A total of 33 patients had 42 episodes of PDAP between January 2014 and September 2016 in our peritoneal dialysis center. A retrospective analysis was made of regarding fingdings of the dialysate cultured,drug sensitivity,therapeutic efficacy and outcomes. Results：The dialysate cultured positive rate was 78. 57%. 69. 70% peritonitis episodes were caused by gram-positive cocci,3. 03% by gram-positive bacillus and 27. 27% by gram-negative bacillus. In the peritonitis episodes caused by gram-positive cocci,86. 96% were resistant to penicillin,followed by oxacillin（57. 14%）,erythrocin（ 50. 00%）,clindamycin（ 47. 83%）,compound sulfamethoxazole（ 47. 62%） and ciprofloxacin（31. 82%）. All the gram-positive cocci were sensitive to vancomycin,linezolid and tigecycline. In the peritonitis episodes caused by gram-negative bacillus,85. 71% were resistant to ampicillin,followed by cefazolin（77. 78%）,cefotaxime（66. 67%）,ceftriaxone（62. 50%）,cefoxitin（50. 00%）,compound sulfamethoxazole（44. 44%） and gentamicin（33. 33%）. All the gram-negative bacillus were sensitive to imipenem,ertapenem and tigecycline. The curative rate of PDAP was 85. 71%. The withdrawal rates in culture-negative peritonitis,gram-negative bacillus and gram-positive cocci were respectively 22. 22%,11. 11% and 8. 70%. Conclusion：The main pathogens of PDAP are gram-positive cocci. The empiric initial treatment of PDAP recommended the use of vancomycin combined amikacin,and which curative rate was 93. 3%.