腹膜透析相关性腹膜炎的致病菌谱和耐药性分析

Analysis of Pathogenic Bacteria Spectrum and Drug Resistance in Patients with Peritoneal Dialysis Associated Peritonitis

目的通过对腹膜透析相关性腹膜炎的致病菌谱和耐药性分析,为临床合理用药提供科学依据。方法回顾性分析成都医学院第一附属医院肾病科2013年8月至2017年8月收治腹膜透析相关性腹膜炎的临床资料。结果共纳入腹膜透析相关性腹膜炎122例次,病原菌培养阳性84例次(68.85%),共检出菌株88株,包括G+菌63株,G-菌21株,真菌3株,抗酸杆菌1株。G+菌以表皮葡萄球菌最常见,G-菌以大肠埃希菌最常见。G+菌对万古霉素、利奈唑胺、替加环素均敏感,对头孢唑林的耐药率为42.86%。G-菌对美罗培南、莫西沙星、哌拉西林/他唑巴坦、头孢噻肟均敏感,对头孢唑肟的耐药率为12.50%。结论腹膜透析相关性腹膜炎的致病菌及耐药性已发生很大变化,虽然G+菌仍为主要致病菌,但头孢唑林已不再适合经验性治疗,可考虑选择万古霉素。

Objective To Investigate the pathogenic bacteria spectrum and drug resistance in patients with peritoneal dialysis associated peritonitis （PDAP） in order to provide the scientific basis for the clinical rational use of drugs. Methods The clinical data of the PDAP patients treated from August of 2013 to August of 2017 in The First Affiliated Hospital of Chengdu Medical College were analyzed retrospectively. Results A total of 122 cases with PDAP were enrolled into this study. There were 84 cases of positive pathogenic bacteria culture accounting for 68.85%, in which there were a total of 88 bacterial strains including 63 strains of gram-positive bacteria, 21 strains of gram-negative bacteria, 3 strains of fungus and 1 strain of acid-fast bacilli. Staphylococcus epidermidis was the most common in the gram-positive bacteria, while Escherichia coli was the most common in the gram-negative bacteria. The gram-positive isolates were all sensitive to vancomycin, linezolid and tigecycline, and the rate of the drug resistance to cefazolin was 42.86%. The gram-negative isolates were all sensitive to meropenem, moxifloxacin, piperacillin/tazobactam and cefotaxime, and the rate of the drug resistance to ceftizoxime was 12.50%. Conclusion The pathogenic bacteria and drug resistance in patients with PDAP have been changed markedly. The gram-positive bacteria is the common pathogenic bacteria in patients with PDAP, but cefazolin is no longer suitable for the empirical treatment and vancomycin can be considered as the substitute.