阳江地区腹膜透析相关性腹膜炎病原菌及耐药性分析的调查研究

Study on Pathogens and Drug Resistance of Peritoneal Dialysis Associated Peritonitis in Yangjiang Area

目的:分析阳江地区腹膜透析相关性腹膜炎(PDAP)的病原菌及耐药性,为腹膜炎的预防和治疗提供依据。方法:选取2018年8月-2020年4月本院肾内科收治的201例腹膜透析患者。按照是否发生PDAP的情况分为腹膜炎组90例与非腹膜炎组111例。分析腹膜炎的病原菌及耐药性情况。结果:两组血红蛋白、血葡萄糖、血肌酐、血清钙、血清镁、血清铁比较,差异均无统计学意义(P>0.05);腹膜炎组血清白蛋白水平、血清磷均低于非腹膜炎组,差异均有统计学意义(P<0.05)。腹膜炎组90例患者,透出液病原菌培养阳性90例,其中混合感染2例,共检出菌株94株,其中革兰阳性菌65株(69.15%),革兰阴性菌28株(29.79%),真菌1株(1.06%)。革兰阳性菌对青霉素G的耐药性最高,对替加环素、利奈唑胺、万古霉素、利福平的耐药率最低;革兰阴性菌对头孢唑林耐药性最高,对厄他培南、头孢哌酮舒巴坦、阿米卡星的耐药率最低。结论:本病的病原菌主要以革兰阳性菌为主,革兰阳性菌对青霉素G的耐药性高,对替加环素、利奈唑胺、万古霉素、利福平基本不耐药;革兰阴性菌感染的患者建议应用厄他培南、头孢哌酮舒巴坦、阿米卡星进行治疗。

Objective:To analyze the pathogens and drug resistance of peritoneal dialysis associated peritonitis(PDAP)in Yangjiang area,so as to provide basis for the prevention and treatment of peritonitis.Method:A total of 201 peritoneal dialysis patients admitted to the department of nephrology of our hospital from August 2018 to April 2020 were selected.The patients were divided into the peritonitis group(n=90)and the non-peritonitis group(n=111)according to the occurrence of PDAP.The pathogenic bacteria and drug resistance of peritonitis were analyzed.Result:There were no significant differences in hemoglobin,blood glucose,serum creatinine,serum calcium,serum magnesium and serum iron between two groups(P>0.05).The levels of serum albumin and serum phosphorus in the peritonitis group were lower than those in the non-peritonitis group,with statistical significance(P<0.05).Of 90 patients in the peritonitis group,90 cases were positive for pathogenic bacteria culture in the efflux,including 2 cases of mixed infection.A total of 94 strains were detected,including 65 strains(69.15%)of Gram-positive bacteria,28 strains(29.79%)of Gram-negative bacteria,and 1 strain(1.06%)of fungus.Gram-positive bacteria had the highest drug resistance to Penicillin G,and the lowest drug resistance rate to Ticacycline,Linezolid,Vancomycin and Rifampicin.Gram-negative bacteria had the highest resistance to Cefazolin,and the lowest resistance rate to Ertapenem,Cefoperazone and Sulbactam and Amikacin.Result:The pathogens of this disease are mainly Gram-positive bacteria,Gram-positive bacteria has high resistance to Penicillin G,and are basically resistant to Tigecycline,Linezolid,Vancomycin and Rifampicin.Patients with Gram-negative bacterial infection are recommended for treatment with Ertapenem,Cefoperazone and Sulbactam,and Amikacin.