腹膜透析相关性腹膜炎的细菌谱及耐药性分析

Analysis of Bacterial Spectrum and Drug Resistance of Peritonitis Associated with Peritoneal Dialysis

目的探讨腹膜透析相关性腹膜炎(PDAP)致病菌谱和药物敏感性变化情况,为临床合理防治PDAP提供参考依据。方法回顾性收集2015年1月1日~2018年12月31日在玉林市第一人民医院肾内科治疗的PDAP患者110例,分析PDAP患者透出液的致菌谱和致病菌耐药性。结果患者透出液细菌培养阳性率为30.00%,其中革兰阳性菌占45.45%,革兰阴性菌占42.42%,真菌占12.12%;革兰阳性菌对青霉素的耐药率最高(93.33%),对苯唑西林、左旋氧氟沙星耐药率也较高,分别为78.57%、35.71%,对万古霉素、利奈唑胺均敏感。革兰阴性菌对庆大霉素、左旋氧氟沙星的耐药率分别为61.54%、57.14%,所有菌株对碳青霉烯类药物以及哌拉西林/他唑巴坦、头孢他啶敏感。结论我院PDAP患者透出液细菌培养阳性率较高,建议临床不再使用头孢唑林和庆大霉素作为PDAP的一线用药,应结合实际检测结果,重新评估经验性抗生素的使用。

Objective To explore the pathogenic bacteria spectrum and drug sensitivity changes of peritoneal dialysis-associated peritonitis(PDAP),and to provide a reference for the reasonable clinical prevention and treatment of PDAP.Methods A retrospective collection of 110 PDAP patients who were treated in the Department of Nephrology,Yulin First People's Hospital from January 1,2015 to December 31,2018,were analyzed for the pathogenic spectrum and pathogenic bacteria resistance of PDAP patients’fluid.Results The positive rate of bacterial culture in the patient's exudate was 30.00%,of which gram-positive bacteria accounted for 45.45%,gram-negative bacteria accounted for 42.42%,and fungi accounted for 12.12%;gram-positive bacteria had the highest resistance rate to penicillin(93.33%).The resistance rates to oxacillin and levofloxacin were also high,78.57% and 35.71% respectively,and they were sensitive to vancomycin and linezolid.The resistance rates of gram-negative bacteria to gentamicin and levofloxacin were 61.54% and 57.14%,respectively.All strains were sensitive to carbapenems,piperacillin/tazobactam,and ceftazidime.Conclusion The positive rate of bacterial culture in the permeate of PDAP patients in our hospital is relatively high.It is recommended that cefazolin and gentamicin should not be used clinically as first-line drugs for PDAP.The use of empirical antibiotics should be reassessed in light of actual test results.