腹膜透析相关性腹膜炎细菌培养及药敏试验分析

目的分析湖州地区腹膜透析相关性腹膜炎（PDAP）的临床资料病原菌培养及药敏试验结果，指导临床预防治疗。方法回顾性分析2013年1月至2016年12月135例次PDAP患者的临床资料及腹透液细菌培养结果，采用MicroScan WalkAway-96系统鉴定菌株和药敏试验。结果135例次PDAP中23．70％发生在透析龄〈1年的患者，尤其集中在前6个月，占第1年的7273％，以后发病率逐年呈下降趋势。97例次培养阳性，阳性率71．85％；在检出的97株菌株中，其中革兰阳性菌83株，占8557％，以葡萄球菌属为主；革兰阴性菌11株，占1134％，以大肠埃希菌为主；真菌3株，占31％。革兰阳性菌对利奈唑胺、利福平、万古霉素最为敏感；革兰阴性菌对头孢他啶、美洛培南的最为敏感治疗后120例次患者治愈，12人拔管，4人死亡。G^＋菌、G^-菌和细菌培养阴性的治疗结局差异无统计学意义，3例真菌感染患者均拔管退出。结论PDAP好发于透析龄〈1年的腹膜透析患者，G^＋菌仍为本中心腹膜炎主要致病菌；经验治疗方案为万古霉素联合头孢他啶。

Objective To analyze the pathogen distribution and susceptibility test of PDAP in Huzhou area and to guide the rational application of antimicrobial agents. Methods Peritoneal dialysis fluid drainage of 135 cases of PDAP from January 2013 to December 2016 were collected, and the MicroScan WalkAway-96 System were used for bacterial culture and strains identification and drug susceptibility test. Results The 23.70% of 135 patients occurred PPAP in the first year of dialysis, specially, in the first six months, accounting for 72.73% of the first year, and then the morbidity decreased year by year. There were 97 cases of culture positive （ 71.85% ） ; 83 strains Gram-positive bacteria were detected in 97 strains （ 85.57% ） , mainly as staphylococcus. Gram-negative bacteria were 11 strains （ 11.34% ） , mainly as Escherichia coli fungus were 3 strains （ 3.1% ） . Gram-positive bacteria were most sensitive to linezolid, rifampicin and vancomycin. Gram negative bacteria were most sensitive to ceftazidime and meropenem. After treatment, 120 patients were cured, 12 withdrew and 4 died. The treatment outcome of Gram-positive bacteria, Gram-negative bacteria and fimgus had no statistical differences. 3 cases of fungal infection were all extnbated and withdrew. Conclusion PDAP had a predilection for peritoneal dialysis patients in the first year. The CAPD-related peritonitis in this center is mainly induced by Gram-positive bacteria. Vancomycin combined with ceftazidime are recommended as the initial empirical treatment in PDAP in our center.