129例次腹膜透析相关性腹膜炎的致病菌分布及药敏分析

Analysis of microbial spectrum and antibiotic resistance in 129 cases patients of peritoneal dialysis related peritonitis

目的腹透相关性腹膜炎仍是导致腹膜透析技术失败及患者死亡的重要原因,通过调查持续性非卧床腹膜透析(CAPD)相关性腹膜炎的病原菌分布及耐药性特点,指导临床更好更及时的针对性治疗,提高治愈率。方法回顾性分析2012年1月1日—2016年12月31日在绍兴市人民医院肾内科腹膜透析中心接受CAPD,且并发腹膜透析相关性腹膜炎患者129例次腹膜透出液培养结果,统计病原菌的分布情况及其对常见抗菌药物的耐药性。结果 129例次CAPD相关性腹膜炎患者中腹膜透出液培养阳性97例次,阳性率为75.19%。共分离出病原菌98株,其中革兰阳性(G^+)菌感染69例(71.14%),革兰阴性(G^-)菌感染26例(26.80%),含1例大肠埃希菌和肺炎克雷伯菌混合感染,真菌感染2例(2.06%)。葡萄球菌对万古霉素、替加环素、利奈唑胺均敏感,对替考拉宁1例中介,1例耐药。链球菌对万古霉素、氯霉素均敏感,肠球菌对万古霉素、替加环素均敏感;G-菌对亚胺培南、美洛培南、厄他培南均敏感。129例次患者中共有1例死亡,2例放弃治疗,5例患者拔管改血透。结论 CAPD相关性腹膜炎致病菌以G+菌为主,推荐头孢唑啉联合哌拉西林/他唑巴坦、头孢哌酮/舒巴坦或丁胺卡那霉素作为腹膜炎的经验性治疗药物,对重症感染可考虑直接万古霉素加头孢哌酮/舒巴坦。

Objective Peritoneal dialysis related peritonitis is still an important cause of failure of peritoneal dialysis and death. To investigate the microbial spectrum and antibiotic resistance of continuous ambulatory peritoneal dialysis（ CAPD） related peritonitis and guide the clinical rational use of antimicrobial agents. Methods A retrospective analysis was made of CAPD related peritonitis in 129 cases with peritoneal dialysis culture results in the Shaoxing People＇s Hospital from January 1,2012 to December 31,2016. Distribution of pathogenic bacteria and its resistance to common antibiotics were analyzed. Results In 129 cases of CAPD related peritonitis,peritoneal fluid culture was positive in 97 cases,the positive rate was 75. 19%. A total of 98 strains of bacteria were isolated,gram positive bacteria infection（ G~＋） in 69 cases（ 71. 14%）,gram negative bacteria infection（ G^-） in 26 cases（ 26. 80%）,including 1 cases of Escherichia coli and Klebsiella pneumoniae infection,fungal infection in 2 cases（ 2. 06%）. Drug sensitivity test of Staphylococcus aureus was sensitive to vancomycin,tigecycline and linezolid,teicoplanin on a case of intermediary and drug resistance. Streptococcus were sensitive to vancomycin,chloramphenicol,vancomycin and Enterococcus were sensitive to tigecycline; Gbacteria were sensitive to imipenem,meropenem and ertapenem. One hundred and twenty-nine cases of patients with a total of 1 cases of death,2 cases give up the treatment,and 5 cases transferred to hemodialysis. Conclusion The main pathogen of CAPD related peritonitis is Gram-positive bacteria. Cefazoline combined with piperacillin/tazobartan,cefoperazone/Shubatan or butanamycin are recommended as empirical drugs for the treatment of peritonitis. Direct vancomycin plus cefoperazone/sulbactam may be considered for severe infection.