162例次腹膜透析相关性腹膜炎病原学分析

Analysis on etiology in 162 case-times of peritoneal dialysis-related peritonitis

目的研究该院腹膜透析相关性腹膜炎透出液的病原菌培养鉴定结果、涂片革兰染色镜检结果、耐药情况,为腹膜透析相关性腹膜炎的临床诊断、治疗、预后及实验室检查提供数据支持。方法回顾性分析2014年1月至2019年4月该院收治的124例腹膜透析相关性腹膜炎患者共162次透出液的病原菌分布、涂片革兰染色镜检结果、耐药情况。结果 162例次透出液检测中,115例次透出液培养阳性,阳性率71.0%。培养出126株病原菌,其中83株革兰阳性球菌(65.9%),34株革兰阴性杆菌(27.0%),6株真菌(4.8%),2株革兰阴性球菌,1株革兰阳性杆菌。115例次透出液培养阳性的腹膜炎患者中有78例次同步送检涂片革兰染色,其中34例次阳性,阳性率43.6%。在病原菌耐药性方面,48.0%葡萄球菌耐苯唑西林,4.8%链球菌耐青霉素,54.5%肠杆菌目细菌耐第3、4代头孢菌素。结论在该院,腹膜透析相关性腹膜炎病原菌以革兰阳性球菌为主;在透析相关性腹膜炎诊治中,应重视透出液涂片革兰染色镜检;应根据病原菌监测情况进行经验性抗菌药物的选择。

Objective To investigate the pathogenic bacterial culture identification results,smear Gram staining microscopic examination results and drug resistance of peritoneal dialysis-related peritonitis(PDAP)dialysate to provide the data support for the diagnosis,treatment,prognosis and laboratory examination of PDAP.Methods The pathogenic bacterial distribution,smear Gram staining microscopic examination results and drug resistance of 162 case-times of dialysates from 124 patients with PDAP from January 2014 to April 2019 were retrospectively analyzed.Results Among 115 case-times of dialysate detection,115 case-times were the culture positive with the positive rate of 71.0%.A total of 126 strains of pathogenic bacteria were cultured,including 83 strains(65.9%)of Gram-positive cocci,34 strains(27.0%)of Gram-negative bacilli,6 strains(4.8%)of fungi,2 strain of Gram-negative cocci and 1 strain of Gram positive bacillus.Among the peritonitis patients with 115 case-times of dialysate culture positive,78 case-times synchronously submited the smear Gram staining,in which 34 cases showed positive,the positive rate was 43.6%.In the aspect of pathogenic bacterial drug resistance,48.0%of staphylococcus was methicillin-resistant,4.8%of streptococcus was resistant to penicillin,45.5%of Enterobacteria was resistant to third or fourth generation cephalosporin.Conclusion Gram-positive cocci is the main pathogenic bacterium in PDAP of this hospital.More attention should be paid to the smear Gram staining microscopic examination of dialysate during the diagnosis and treatment of PDAP.The selection of empirical antibacterial drugs should be conducted based on the bacteriological monitoring situation.